Organization
EVERGREEN ABA LLC
Active
Parent organization
LATITUDE ABA HOLDINGS LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LATITUDE ABA HOLDINGS LLC
Authorized official
TALIA SCHUSS (CEO)
(314) 410-9670
Entity
Organization
Contact information
Practice address
900 SE 5TH STREET, BENTONVILLE, AR 72712
(314) 410-9670
Mailing address
8130 BALSON AVE., ST. LOUIS, MO 63130
(314) 410-9670
(855) 611-8213
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
730082591
—
MO
Enumeration date
03/05/2024
Last updated
11/07/2024
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