Healthcare Provider Details

I. General information

NPI: 1790625838
Provider Name (Legal Business Name): MOUNTAIN ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SUNSTONE DR NW
ALBUQUERQUE NM
87120-8024
US

IV. Provider business mailing address

2300 SUNSTONE DR NW
ALBUQUERQUE NM
87120-8024
US

V. Phone/Fax

Practice location:
  • Phone: 505-333-8718
  • Fax:
Mailing address:
  • Phone: 505-333-8718
  • 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: ANDRE AZEVEDO
Title or Position: BCBA
Credential: M.ED.
Phone: 817-526-8290