Provider Demographics
NPI:1083244958
Name:AUTISM BEHAVIOR SUPPORT, LLC
Entity Type:Organization
Organization Name:AUTISM BEHAVIOR SUPPORT, LLC
Other - Org Name:MARY AYALA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:719-352-2970
Mailing Address - Street 1:5212 ALLEGANY DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5648
Mailing Address - Country:US
Mailing Address - Phone:719-352-2970
Mailing Address - Fax:
Practice Address - Street 1:4003 W STAN SCHLUETER LOOP STE 3
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6120
Practice Address - Country:US
Practice Address - Phone:719-352-2970
Practice Address - Fax:254-267-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2020-07-20
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTRICAREOtherTRICARE