MEDICARE: TIME 2 GROW ABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1023664737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIME 2 GROW ABA

Provider Business Mailing Address
First Line	:	11501 DUBLIN BLVD
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-2826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11501 DUBLIN BLVD
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-2826
Country	:	US
Telephone Number	:	925-339-4599
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	SHAYLA DUDA
Credential	:	BCBA
Telephone Number	:	415-246-7901

Provider Enumeration Date	:	08/18/2019
Last Update Date	:	08/18/2019

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