Healthcare Provider Details

I. General information

NPI: 1194472787
Provider Name (Legal Business Name): PHOENIX ABA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 QUEST CT
KELLER TX
76248-3748
US

IV. Provider business mailing address

3920 DREXMORE RD
FORT WORTH TX
76244-8510
US

V. Phone/Fax

Practice location:
  • Phone: 682-593-3182
  • Fax: 817-498-1426
Mailing address:
  • Phone: 817-948-9367
  • 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: MARIAH LAND
Title or Position: OWNER
Credential: BCBA
Phone: 817-948-9367