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General NPI Number Information
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NPI Number | 1770091894
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Entity Type | Organization
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Legal Business Name | MOBILE BAY ABA, LLC
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 1903 SPRING HILL AVE
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City | MOBILE
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State | AL
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Zip | 36607-2303
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Country | US
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Telephone | 251-215-9222
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Fax | 888-844-2292
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Provider Business Mailing Address
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Address Line | 1903 SPRING HILL AVE
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City | MOBILE
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State | AL
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Zip | 36607-2303
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Country | US
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Telephone | 251-215-9222
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Fax | 888-844-2292
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOSHUA LEVINE
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Credential | PH.D., BCBA, LBA
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Telephone | 251-215-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2017-068
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License Number State | AL
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