Healthcare Provider Details

I. General information

NPI: 1851157762
Provider Name (Legal Business Name): MAGIC VALLEY ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W YAKIMA STE 1
JEROME ID
83338-6164
US

IV. Provider business mailing address

PO BOX 69
HAGERMAN ID
83332-0069
US

V. Phone/Fax

Practice location:
  • Phone: 208-886-0534
  • Fax: 208-278-8439
Mailing address:
  • Phone: 208-421-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTA A MAHLER
Title or Position: OWNER
Credential: MA
Phone: 208-421-7096