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General NPI Number Information
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NPI Number | 1265134563
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Entity Type | Organization
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Legal Business Name | VITALITY ABA LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 60 N BERETANIA ST APT 1406
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City | HONOLULU
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State | HI
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Zip | 96817-4757
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Country | US
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Telephone | 801-810-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 60 N BERETANIA ST APT 1406
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City | HONOLULU
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State | HI
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Zip | 96817-4757
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Country | US
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Telephone | 801-810-8346
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | RACHEL LYNN BOEHMERT
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Credential |
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Telephone | 801-810-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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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 |
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Taxonomy #3
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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 |
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