Basic Information
| Provider Information | |||||||||
| NPI: | 1871198648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAMASTE ABA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 742 E BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450502499 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 742 E BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450502499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144200623 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | HIGHTOWER | ||||||||
| AuthorizedOfficialFirstName: | OASCHA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6144200623 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.