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General NPI Number Information
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NPI Number | 1003314402
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Entity Type | Organization
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Legal Business Name | ABA FAMILY SERVICES
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 2074 SE DOVERBROOK ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-4698
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Country | US
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Telephone | 772-905-8836
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Fax |
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Provider Business Mailing Address
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Address Line | 2074 SE DOVERBROOK ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-4698
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON KIESS
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Credential | M.ED., BCBA
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Telephone | 772-530-0575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11623919
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License Number State | FL
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