Provider Demographics
NPI:1114688660
Name:PROJECT ODYSSEY ABA, LLC
Entity type:Organization
Organization Name:PROJECT ODYSSEY ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUGEAU
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA, MA
Authorized Official - Phone:337-292-5906
Mailing Address - Street 1:18840 NW ROCK CREEK CIR APT 285
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7204
Mailing Address - Country:US
Mailing Address - Phone:337-602-8884
Mailing Address - Fax:618-418-4422
Practice Address - Street 1:18840 NW ROCK CREEK CIR APT 285
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7204
Practice Address - Country:US
Practice Address - Phone:337-292-5906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty