MEDICARE: ABA CENTER OF EXCELLENCE FOR AUTISM LLC (ACE FOR AUTISM)

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	:	1699387944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA CENTER OF EXCELLENCE FOR AUTISM LLC (ACE FOR AUTISM)

Provider Business Mailing Address
First Line	:	7353 E SUGARLOAF ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-0948
Country	:	US
Telephone Number	:	480-652-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	7353 E SUGARLOAF ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-0948
Country	:	US
Telephone Number	:	480-652-3250
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VALERIE SMITH
Credential	:	BCBA LBA
Telephone Number	:	480-652-3250

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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