# EVERGREEN ABA LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LATITUDE ABA HOLDINGS LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558128553
- **Legal business name:** LATITUDE ABA HOLDINGS LLC
- **Authorized official:** TALIA SCHUSS (CEO)
- **Authorized official phone:** (314) 410-9670

## Contact information

- **Practice address:** 900 SE 5TH STREET, BENTONVILLE, AR 72712
- **Practice address phone:** (314) 410-9670
- **Mailing address:** 8130 BALSON AVE., ST. LOUIS, MO 63130
- **Mailing address phone:** (314) 410-9670
- **Mailing address fax:** (855) 611-8213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 03/05/2024
- **Last updated:** 11/07/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 730082591 | — | MO |