Provider Demographics
NPI:1043571334
Name:AUTISM ADVANTAGE, LLP.
Entity Type:Organization
Organization Name:AUTISM ADVANTAGE, LLP.
Other - Org Name:AUTISM ADVANTAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-650-8639
Mailing Address - Street 1:1004 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2002
Mailing Address - Country:US
Mailing Address - Phone:512-650-8639
Mailing Address - Fax:
Practice Address - Street 1:1004 W 31ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2002
Practice Address - Country:US
Practice Address - Phone:512-650-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33891103T00000X
CO3727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty