# ABA BEHAVIORAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073297305
- **Authorized official:** FATHI MOHAMUD MOHAMED (CEO)
- **Authorized official phone:** (202) 779-1350

## Contact information

- **Practice address:** 2719 W DIVISION ST STE 107, SAINT CLOUD, MN 56301-3409
- **Practice address phone:** (202) 779-1350
- **Mailing address:** 2719 W DIVISION ST STE 107, SAINT CLOUD, MN 56301-3409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 06/15/2023
- **Last updated:** 06/15/2023