| Coastal Aba, Llc | |
|
6001 41st Ave N St Petersburg FL 33709-5221 | |
| (727) 656-6045 | |
| (727) 656-6045 |
| Full Name | Coastal Aba, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 6001 41st Ave N, St Petersburg, Florida |
| Authorized Official Name and Position | Lauren Altman Brum (OWNER, BEHAVIOR ANALYST) |
| Authorized Official Contact | 7278883296 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Aba, Llc 3135 1st Ave N, Po Box 12844 St. Petersburg FL 33730 Ph: (727) 999-0583 | Coastal Aba, Llc 6001 41st Ave N St Petersburg FL 33709-5221 Ph: (727) 656-6045 |
| NPI Number | 1851800726 |
|---|---|
| Provider Enumeration Date | 09/23/2017 |
| Last Update Date | 09/23/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851800726 | NPI | - | NPPES |
| 1073972451 | Medicaid | FL | |
| 1700266871 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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