MEDICARE: LOVE FORWARD 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	:	1447198882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE FORWARD ABA LLC

Provider Business Mailing Address
First Line	:	1621 CENTRAL AVE
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 CENTRAL AVE
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:	559-874-5875
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	BRIAN PENA
Credential	:	M.ED. BCBA, LBA
Telephone Number	:	559-874-5875

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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