Healthcare Provider Details

I. General information

NPI: 1740813088
Provider Name (Legal Business Name): GOLDEN STEPS ABA NE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 FARNAM ST STE 300
OMAHA NE
68102-1857
US

IV. Provider business mailing address

600 3RD AVE FL 2
NEW YORK NY
10016-1919
US

V. Phone/Fax

Practice location:
  • Phone: 615-570-9959
  • Fax: 646-859-4440
Mailing address:
  • Phone: 615-570-9959
  • Fax: 646-859-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: REBECCA ROSS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 678-894-1116