Provider Demographics
NPI:1386355584
Name:INCLUSIVE ABA CO LLC
Entity type:Organization
Organization Name:INCLUSIVE ABA CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-616-1188
Mailing Address - Street 1:1525 PROSPECT ST STE 603
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4642
Mailing Address - Country:US
Mailing Address - Phone:303-616-1188
Mailing Address - Fax:303-616-1189
Practice Address - Street 1:155 BOARDWALK DR # 490
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3040
Practice Address - Country:US
Practice Address - Phone:303-616-1188
Practice Address - Fax:303-616-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty