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Organization
SOUTH PUGET SOUND ABA LLC
Active
Organization
SOUTH PUGET SOUND ABA LLC
Active
Other names
South Puget Sound ABA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SEAN KEITH (BUSINESS MANAGER)
(360) 819-8180
Entity
Organization
Contact information
Practice address
314 RIVER HEIGHTS RD, CENTRALIA, WA 98531-8830
(360) 819-8180
Mailing address
314 RIVER HEIGHTS RD, CENTRALIA, WA 98531-8830
(360) 819-8180
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60792556
WA STATE DEPARTMENT OF HEALTH LICENSE NUMBER
WA
Enumeration date
09/18/2018
Last updated
09/18/2018
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