Provider Demographics
NPI:1073108320
Name:AUTISM SUPPORT NASHVILLE LLC
Entity Type:Organization
Organization Name:AUTISM SUPPORT NASHVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-860-7198
Mailing Address - Street 1:3003 GARI BALDI WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6282
Mailing Address - Country:US
Mailing Address - Phone:815-630-6408
Mailing Address - Fax:815-770-7433
Practice Address - Street 1:3003 GARI BALDI WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6282
Practice Address - Country:US
Practice Address - Phone:815-630-6408
Practice Address - Fax:815-770-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty