Healthcare Provider Details

I. General information

NPI: 1205730124
Provider Name (Legal Business Name): PEBBLE ABA MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TROOST AVE
KANSAS CITY MO
64108-1540
US

IV. Provider business mailing address

229 ROUTE 70
TOMS RIVER NJ
08755-1026
US

V. Phone/Fax

Practice location:
  • Phone: 314-549-7237
  • Fax: 314-549-7254
Mailing address:
  • Phone: 314-549-7237
  • Fax: 314-549-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAIM KAUFMAN
Title or Position: CEO
Credential:
Phone: 314-549-7237