Provider Demographics
NPI:1730951393
Name:BLUE CACTUS ABA LLC
Entity type:Organization
Organization Name:BLUE CACTUS ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNICA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:480-536-3343
Mailing Address - Street 1:3961 E NORCROFT CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1084
Mailing Address - Country:US
Mailing Address - Phone:360-791-3733
Mailing Address - Fax:
Practice Address - Street 1:3961 E NORCROFT CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1084
Practice Address - Country:US
Practice Address - Phone:360-791-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty