MEDICARE: POSITIVE CHANGE 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	:	1366017857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE CHANGE ABA LLC

Provider Business Mailing Address
First Line	:	707 S EAGLE ST
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-8880
Country	:	US
Telephone Number	:	417-294-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 S EAGLE ST
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-8880
Country	:	US
Telephone Number	:	417-294-1178
Fax Number	:

Authorized Official
Title or Position	:	OWNER, BCBA, LBA
Name	:	NICOLE RAE MCDONALD
Credential	:	BCBA, LBA
Telephone Number	:	417-294-1178

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	02/15/2026

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