=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730759960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABA CHANGING BEHAVIORS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2021
-----------------------------------------------------
Last Update Date | 06/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 338 S EAST AVE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-839-6835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 338 S EAST AVE
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-839-6835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR-OWNER
-----------------------------------------------------
Name | KIM TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-839-6835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------