Provider Demographics
NPI:1689474207
Name:MY ABA ARIZONA LLC
Entity type:Organization
Organization Name:MY ABA ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-218-7576
Mailing Address - Street 1:1353 N FULLER AVE PH 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4996
Mailing Address - Country:US
Mailing Address - Phone:541-218-7576
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE R
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4639
Practice Address - Country:US
Practice Address - Phone:541-218-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty