1407798812 NPI number — BEHAVIOR CENTRAL ABA

Table of content: (NPI 1407798812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407798812 NPI number — BEHAVIOR CENTRAL ABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIOR CENTRAL ABA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407798812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 ASHLEY PARK DR APT I107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30263-3243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-648-2221
Provider Business Mailing Address Fax Number:
770-648-2221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3025 GA HIGHWAY 154
Provider Second Line Business Practice Location Address:
UNIT D
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-6148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-648-2221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2026

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
OWNER, CEO
Authorized Official Telephone Number:
770-648-2221

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-17-25904 . This is a "BEHAVIOR ANALYST CERTIFICATION BOARD" identifier . This identifiers is of the category "OTHER".




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