Provider Demographics
NPI:1386464352
Name:SUNFLOWER CENTER ABA SERVICES, LLC
Entity type:Organization
Organization Name:SUNFLOWER CENTER ABA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GODBOUT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:802-528-6332
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:ENOSBURG FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05450-0223
Mailing Address - Country:US
Mailing Address - Phone:802-528-6332
Mailing Address - Fax:
Practice Address - Street 1:2017 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:ENOSBURG FALLS
Practice Address - State:VT
Practice Address - Zip Code:05450-5047
Practice Address - Country:US
Practice Address - Phone:802-933-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty