Provider Demographics
NPI:1780944355
Name:ABA CONSULTATION & IN-HOME THERAPY, LLC
Entity type:Organization
Organization Name:ABA CONSULTATION & IN-HOME THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MCKEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-703-0573
Mailing Address - Street 1:706 E CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3861
Mailing Address - Country:US
Mailing Address - Phone:715-703-0573
Mailing Address - Fax:
Practice Address - Street 1:706 E CAMPUS DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3861
Practice Address - Country:US
Practice Address - Phone:715-703-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty