Provider Demographics
NPI:1699420174
Name:AGAPE ABA
Entity type:Organization
Organization Name:AGAPE ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:385-230-1684
Mailing Address - Street 1:868 WEST 200 SOUTH STREET
Mailing Address - Street 2:B107
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8567
Mailing Address - Country:US
Mailing Address - Phone:385-230-1684
Mailing Address - Fax:
Practice Address - Street 1:868 WEST 200 SOUTH STREET
Practice Address - Street 2:B107
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-8400
Practice Address - Country:US
Practice Address - Phone:385-230-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021904200Medicaid