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General NPI Number Information
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NPI Number | 1407661721
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Entity Type | Organization
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Legal Business Name | MEMOREABLE ABA LLC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 27911 CROWN LAKE BLVD STE 200
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4218
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Country | US
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Telephone | 800-961-3367
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Fax | 800-961-3367
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Provider Business Mailing Address
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Address Line | 27911 CROWN LAKE BLVD
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4210
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Country | US
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Telephone | 800-961-3367
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Fax | 800-961-3367
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAVELYN MILLARD
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Credential |
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Telephone | 239-396-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 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 #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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