Healthcare Provider Details

I. General information

NPI: 1033075171
Provider Name (Legal Business Name): LIBERTY ABA ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 MERLOT AVE UNIT 210
GRAPEVINE TX
76051-7386
US

IV. Provider business mailing address

4821 MERLOT AVE UNIT 210
GRAPEVINE TX
76051-7386
US

V. Phone/Fax

Practice location:
  • Phone: 858-335-5181
  • Fax:
Mailing address:
  • Phone: 858-335-5181
  • Fax: 858-335-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JEFF STAPLETON
Title or Position: MEMBER/OWNER
Credential: MBA
Phone: 858-335-5181