Provider Demographics
NPI:1316374937
Name:TAG ABA LLC
Entity type:Organization
Organization Name:TAG ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-513-7178
Mailing Address - Street 1:5024 W PATTERSON AVE
Mailing Address - Street 2:2R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3413
Mailing Address - Country:US
Mailing Address - Phone:810-513-7178
Mailing Address - Fax:
Practice Address - Street 1:5024 W PATTERSON AVE
Practice Address - Street 2:2R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3413
Practice Address - Country:US
Practice Address - Phone:810-513-7178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty