MEDICARE: TRANSFORMATIVE ABA LLC

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	:	1356123194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIVE ABA LLC

Provider Business Mailing Address
First Line	:	142 COUNTY RANCH ROAD 2748
Second Line	:
City	:	RIO FRIO
State	:	TX
Zip	:	78879
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 COUNTY RANCH ROAD 2748
Second Line	:
City	:	RIO FRIO
State	:	TX
Zip	:	78879
Country	:	US
Telephone Number	:	830-279-6157
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MELISSA AHLSCHLAGER
Credential	:	BCBA
Telephone Number	:	830-279-6157

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	01/25/2024

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