Provider Demographics
NPI:1306677893
Name:ELEVATE ABA LLC
Entity type:Organization
Organization Name:ELEVATE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGARMO SESIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-216-8567
Mailing Address - Street 1:4798 S FLORIDA AVE # 223
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2181
Mailing Address - Country:US
Mailing Address - Phone:863-216-8567
Mailing Address - Fax:
Practice Address - Street 1:211 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:863-216-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty