Provider Demographics
NPI:1871277632
Name:BLUE GEMS ABA MO LLC
Entity type:Organization
Organization Name:BLUE GEMS ABA MO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-297-7998
Mailing Address - Street 1:800 E 101ST TER STE 350
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-5310
Mailing Address - Country:US
Mailing Address - Phone:617-297-7998
Mailing Address - Fax:617-340-3371
Practice Address - Street 1:800 E 101ST TER STE 350
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-5310
Practice Address - Country:US
Practice Address - Phone:816-371-4180
Practice Address - Fax:617-340-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty