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General NPI Number Information
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NPI Number | 1205730785
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Entity Type | Organization
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Legal Business Name | PINE TREE ABA THERAPY LLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 4210 N FRONTAGE RD STE E
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5036
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Country | US
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Telephone | 479-480-5804
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 NW FRONTAGE RD STE 6
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City | BENTONVILLE
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State | AR
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Zip | 72712-9254
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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 | MEMBER
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Name | ASHER LAX
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Credential |
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Telephone | 479-480-5804
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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 |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NULL
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