Provider Demographics
NPI:1538989926
Name:TREESIDE ABA - BEHAVIORAL
Entity type:Organization
Organization Name:TREESIDE ABA - BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:859-285-2103
Mailing Address - Street 1:6900 HOUSTON RD STE 26
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4890
Mailing Address - Country:US
Mailing Address - Phone:859-285-2103
Mailing Address - Fax:
Practice Address - Street 1:6900 HOUSTON RD STE 26
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4890
Practice Address - Country:US
Practice Address - Phone:859-285-2103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty