Provider Demographics
NPI:1174103378
Name:BRILLIANT MINDS ABA LLC
Entity type:Organization
Organization Name:BRILLIANT MINDS ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:678-208-9893
Mailing Address - Street 1:7465 HIGHTOWER CIR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-1374
Mailing Address - Country:US
Mailing Address - Phone:678-208-9893
Mailing Address - Fax:435-608-9376
Practice Address - Street 1:7465 HIGHTOWER CIR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-1374
Practice Address - Country:US
Practice Address - Phone:678-208-9893
Practice Address - Fax:435-608-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003246117Medicaid