Healthcare Provider Details

I. General information

NPI: 1518523745
Provider Name (Legal Business Name): ABA COOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W EDMOND RD
EDMOND OK
73003-5600
US

IV. Provider business mailing address

330 W EDMOND RD
EDMOND OK
73003-5600
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-3391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY MALWICK
Title or Position: MANAGING MEMBER
Credential: BCBA
Phone: 405-202-6510