Provider Demographics
NPI:1083412928
Name:NEUROSPROUT ABA MD LLC
Entity type:Organization
Organization Name:NEUROSPROUT ABA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SELEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-332-8893
Mailing Address - Street 1:1241 EDRIS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1113
Mailing Address - Country:US
Mailing Address - Phone:213-332-8893
Mailing Address - Fax:
Practice Address - Street 1:1777 REISTERSTOWN RD STE 290
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1390
Practice Address - Country:US
Practice Address - Phone:213-332-8893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty