=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023409430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER ABA CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2015
-----------------------------------------------------
Last Update Date | 02/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13940 CEDAR RD STE 303
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-246-9670
-----------------------------------------------------
Fax | 216-371-1426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13940 CEDAR RD STE 303
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-246-9670
-----------------------------------------------------
Fax | 216-371-1426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DEBORAH M NEWMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-246-9670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------