Provider Demographics
NPI:1104191758
Name:AUTISM THERAPIES LLC
Entity Type:Organization
Organization Name:AUTISM THERAPIES LLC
Other - Org Name:SUMMY FAMILY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUMMY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:817-925-2979
Mailing Address - Street 1:594 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3500
Mailing Address - Country:US
Mailing Address - Phone:817-925-2979
Mailing Address - Fax:
Practice Address - Street 1:594 GARDEN CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3500
Practice Address - Country:US
Practice Address - Phone:817-925-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01-12-10467103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty