Provider Demographics
NPI:1962868331
Name:BRAIN BRIDGE ABA, LLC
Entity type:Organization
Organization Name:BRAIN BRIDGE ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, M ED, BCBA
Authorized Official - Phone:719-439-0029
Mailing Address - Street 1:1098 PROVENCE PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132
Mailing Address - Country:US
Mailing Address - Phone:719-439-0029
Mailing Address - Fax:210-855-7844
Practice Address - Street 1:1098 PROVENCE PL
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132
Practice Address - Country:US
Practice Address - Phone:719-439-0029
Practice Address - Fax:210-855-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11416807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty