Healthcare Provider Details

I. General information

NPI: 1376452102
Provider Name (Legal Business Name): ABA THERAPY ONLINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HIGH SIERRA DR
VALPARAISO IN
46385-5383
US

IV. Provider business mailing address

2357 ANDERSON BEND RD
RUSSELLVILLE TN
37860-9407
US

V. Phone/Fax

Practice location:
  • Phone: 219-312-0494
  • Fax:
Mailing address:
  • Phone: 616-292-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH A ADAMS
Title or Position: CO-FOUNDER
Credential:
Phone: 616-292-6003