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General NPI Number Information
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NPI Number | 1316577000
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Entity Type | Organization
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Legal Business Name | MY ABA SERVICES LLC
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1353 N FULLER AVE PH 2
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City | LOS ANGELES
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State | CA
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Zip | 90046-4996
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Country | US
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Telephone | 541-218-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 1353 N FULLER AVE PH 2
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City | LOS ANGELES
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State | CA
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Zip | 90046-4996
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Country | US
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Telephone | 541-218-7576
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Fax | 213-277-4944
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. BLAYNE MILBURN
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Credential |
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Telephone | 541-218-7576
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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