MEDICARE: NOAHS ARK ABA AND AUTISM SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1447808944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOAHS ARK ABA AND AUTISM SERVICES

Provider Business Mailing Address
First Line	:	14413 S ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14413 S ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7233
Country	:	US
Telephone Number	:	405-203-4707
Fax Number	:	405-805-6612

Authorized Official
Title or Position	:	OWNER
Name	:	NOAH MINTON
Credential	:	BCBA
Telephone Number	:	405-203-4707

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	08/28/2019

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