=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740779834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRIVE ABA CONSULTANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5060 171ST ST
-----------------------------------------------------
City | TINLEY PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60477-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-589-4667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 S CHESTNUT CT
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60425-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-689-7416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER, CEO
-----------------------------------------------------
Name | SALENA IYARE
-----------------------------------------------------
Credential | MA, BCBA
-----------------------------------------------------
Telephone | 773-589-4667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------