MEDICARE: ABA MAGICAL MOMENTS VA 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	:	1750065454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA MAGICAL MOMENTS VA LLC

Provider Business Mailing Address
First Line	:	405 E LABURNUM AVE STE 3-200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2120
Country	:	US
Telephone Number	:	317-648-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 E LABURNUM AVE STE 3-200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2120
Country	:	US
Telephone Number	:	317-648-9509
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACOB KLEIN
Credential	:
Telephone Number	:	317-648-9509

Provider Enumeration Date	:	06/13/2023
Last Update Date	:	06/13/2023

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Directions to “ABA MAGICAL MOMENTS VA LLC ” Practice Location

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