| Kids Place 4 Aba Inc | |
|
3079 Harrison Ave #12 Suite 111 South Lake Tahoe CA 96150 | |
| (775) 710-1688 | |
| Not Available |
| Full Name | Kids Place 4 Aba Inc |
|---|---|
| Speciality | Behavior Technician |
| Location | 3079 Harrison Ave #12, South Lake Tahoe, California |
| Authorized Official Name and Position | Amy Copenhaver (OWNER) |
| Authorized Official Contact | 7757101688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Place 4 Aba Inc 2106 Chicory Way Reno NV 89509-5844 Ph: (775) 710-1688 | Kids Place 4 Aba Inc 3079 Harrison Ave #12 Suite 111 South Lake Tahoe CA 96150 Ph: (775) 710-1688 |
| NPI Number | 1912621780 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 03/02/2026 |
| Certification Date | 03/02/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912621780 | NPI | - | NPPES |
| 881323141 | Medicaid | NV | |
| EIN | Other | MEDICAL BIILING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106S00000X | Behavior Technician | (* (Not Available)) | Primary |
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