Provider Demographics
NPI:1396431144
Name:FOREVER LEARNING ABA, LLC
Entity type:Organization
Organization Name:FOREVER LEARNING ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERTAURUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:WARMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:573-462-6792
Mailing Address - Street 1:12317 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-6602
Mailing Address - Country:US
Mailing Address - Phone:573-462-6792
Mailing Address - Fax:
Practice Address - Street 1:6831 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3620
Practice Address - Country:US
Practice Address - Phone:573-462-6792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty