Healthcare Provider Details

I. General information

NPI: 1679311005
Provider Name (Legal Business Name): HEALE ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 CLIFF GOOKIN BLVD
TUPELO MS
38801-6558
US

IV. Provider business mailing address

143C WILLOWBROOK DR
SALTILLO MS
38866-6896
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-0098
  • Fax: 662-495-4079
Mailing address:
  • Phone: 662-205-0098
  • Fax: 662-495-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM KLEIN
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 662-205-0655