| South Puget Sound Aba Llc | |
|
314 River Heights Rd Centralia WA 98531-8830 | |
| (360) 819-8180 | |
| Not Available |
| Full Name | South Puget Sound Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 314 River Heights Rd, Centralia, Washington |
| Authorized Official Name and Position | Michael Sean Keith (BUSINESS MANAGER) |
| Authorized Official Contact | 3608198180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Puget Sound Aba Llc 314 River Heights Rd Centralia WA 98531-8830 Ph: (360) 819-8180 | South Puget Sound Aba Llc 314 River Heights Rd Centralia WA 98531-8830 Ph: (360) 819-8180 |
| NPI Number | 1376027086 |
|---|---|
| Provider Enumeration Date | 09/18/2018 |
| Last Update Date | 09/18/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376027086 | NPI | - | NPPES |
| 60792556 | Other | WA | WA STATE DEPARTMENT OF HEALTH LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Secondary |
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