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NPI Code Detail

MEDICARE: SHELLY MIICAH ABA INC

MEDICARE: SHELLY MIICAH ABA INC
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
1103K00000XBehavior Analyst1-14-17377CO

General Provider Information

NPI Number : 1396255527
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELLY MIICAH ABA INC
Provider Business Mailing Address
First Line : 2515 HANNAH RIDGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-2550
Country : US
Telephone Number : 719-235-2796
Fax Number : 719-960-2842
Provider Business Practice Location Address
First Line : 2515 HANNAH RIDGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-2550
Country : US
Telephone Number : 719-235-2796
Fax Number : 719-960-2842
Authorized Official
Title or Position : OWNER
Name : MRS. SHELLY MICAH CHILDS
Credential : BCBA
Telephone Number : 719-235-2796
Provider Enumeration Date : 10/02/2017
Last Update Date : 06/10/2026

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