Provider Demographics
NPI:1992079842
Name:B.A.S.I.C. ABA, LLC
Entity type:Organization
Organization Name:B.A.S.I.C. ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUILANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:817-689-6929
Mailing Address - Street 1:607 W PARKWAY ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-9049
Mailing Address - Country:US
Mailing Address - Phone:817-689-6929
Mailing Address - Fax:940-808-0265
Practice Address - Street 1:607 W PARKWAY ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-9049
Practice Address - Country:US
Practice Address - Phone:817-689-6929
Practice Address - Fax:940-808-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-08-4680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty