=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679145205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAND ABA THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2021
-----------------------------------------------------
Last Update Date | 07/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15516 N 172ND DR
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85388-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-633-3704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16772 W BELL RD STE 110-275
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-9702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-633-3704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DARCY D CAVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-633-3704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------