MEDICARE: ABA THERAPY & CONSULTING 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578968780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA THERAPY & CONSULTING SERVICES

Provider Business Mailing Address
First Line	:	200 GROVE PARK LN STE 110
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-5912
Country	:	US
Telephone Number	:	334-305-0297
Fax Number	:	334-777-2355

Provider Business Practice Location Address
First Line	:	200 GROVE PARK LN STE 110
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-5912
Country	:	US
Telephone Number	:	334-305-0297
Fax Number	:	334-777-2355

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KARA ETHEREDGE
Credential	:	M.A., BCBA
Telephone Number	:	334-714-3696

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	12/09/2024

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