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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