Healthcare Provider Details

I. General information

NPI: 1447149356
Provider Name (Legal Business Name): UNITED PATHWAYS ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 21ST ST STE 400A
LINCOLN NE
68510-1044
US

IV. Provider business mailing address

200 S 21ST ST STE 400A
LINCOLN NE
68510-1044
US

V. Phone/Fax

Practice location:
  • Phone: 917-863-3254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: RACHAMIM FAZILOV
Title or Position: CO-FOUNDER
Credential:
Phone: 917-863-3254