Healthcare Provider Details

I. General information

NPI: 1316524101
Provider Name (Legal Business Name): ABA CLASSROOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 WAINEE ST
LAHAINA HI
96761-1109
US

IV. Provider business mailing address

6 KILI NAHE ST
LAHAINA HI
96761-8836
US

V. Phone/Fax

Practice location:
  • Phone: 808-446-4561
  • Fax:
Mailing address:
  • Phone: 808-446-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: GOLDEAN LOWE
Title or Position: OWNER/ OPERATOR
Credential: BCBA LBA
Phone: 808-446-4561