| Evergreen Aba Llc | |
|
900 Se 5th Street Bentonville AR 72712 | |
| (314) 410-9670 | |
| Not Available |
| Full Name | Evergreen Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 900 Se 5th Street, Bentonville, Arkansas |
| Authorized Official Name and Position | Talia Schuss (CEO) |
| Authorized Official Contact | 3144109670 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Aba Llc 8130 Balson Ave. St. Louis MO 63130 Ph: (314) 410-9670 | Evergreen Aba Llc 900 Se 5th Street Bentonville AR 72712 Ph: (314) 410-9670 |
| NPI Number | 1558128553 |
|---|---|
| Provider Enumeration Date | 03/05/2024 |
| Last Update Date | 11/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558128553 | NPI | - | NPPES |
| 730082591 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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