MEDICARE: EAGLES AERIE ABA SERVICES 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	:	1427900042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLES AERIE ABA SERVICES LLC

Provider Business Mailing Address
First Line	:	2140 E SOUTHLAKE BLVD STE L678
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6516
Country	:	US
Telephone Number	:	310-528-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3314 WILLOW RIDGE CIR
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2760
Country	:	US
Telephone Number	:	310-528-8303
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	TANIA EUFEMIA
Credential	:	BCBA, LBA
Telephone Number	:	310-528-8303

Provider Enumeration Date	:	02/14/2026
Last Update Date	:	04/20/2026

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