Healthcare Provider Details

I. General information

NPI: 1043130131
Provider Name (Legal Business Name): AWESOME ACTIVE KIDS ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 BLUE DIAMOND ROAD SUITE 102 PMB1148
LAS VEGAS NV
89139
US

IV. Provider business mailing address

5155 BLUE DIAMOND ROAD SUITE 102 PMB1148
LAS VEGAS NV
89139
US

V. Phone/Fax

Practice location:
  • Phone: 831-741-6552
  • Fax:
Mailing address:
  • Phone: 831-741-6552
  • 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: BELINDA ISABEL PEOPLES
Title or Position: BCBA/MANAGING MEMBER
Credential: BCBA, LBA
Phone: 831-741-6552