Provider Demographics
NPI:1417782780
Name:TRUETRUST ABA THERAPY LLC
Entity type:Organization
Organization Name:TRUETRUST ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAGIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUHOUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-721-3925
Mailing Address - Street 1:5220 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3310
Mailing Address - Country:US
Mailing Address - Phone:313-721-3925
Mailing Address - Fax:
Practice Address - Street 1:5220 HARTWELL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3310
Practice Address - Country:US
Practice Address - Phone:313-721-3925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty