Healthcare Provider Details

I. General information

NPI: 1336651736
Provider Name (Legal Business Name): GREAT HEIGHTS ABA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E RUDISILL BLVD STE B100
FORT WAYNE IN
46806-1738
US

IV. Provider business mailing address

201 E RUDISILL BLVD STE B100
FORT WAYNE IN
46806-1738
US

V. Phone/Fax

Practice location:
  • Phone: 260-255-3665
  • Fax:
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY COOPER
Title or Position: CEO
Credential: EDD, BCBA
Phone: 260-479-0294