Provider Demographics
NPI:1235968751
Name:SHINING LIGHT ABA LLC
Entity type:Organization
Organization Name:SHINING LIGHT ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-570-4545
Mailing Address - Street 1:171 VZ COUNTY ROAD 4114
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-5651
Mailing Address - Country:US
Mailing Address - Phone:903-368-3741
Mailing Address - Fax:888-518-6656
Practice Address - Street 1:171 VZ COUNTY ROAD 4114
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-5651
Practice Address - Country:US
Practice Address - Phone:903-368-3741
Practice Address - Fax:888-518-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty