Provider Demographics
NPI:1124562228
Name:TLC AUTISM SERVICES, LLC
Entity Type:Organization
Organization Name:TLC AUTISM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-601-7631
Mailing Address - Street 1:36 S SEMORAN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3262
Mailing Address - Country:US
Mailing Address - Phone:407-601-7631
Mailing Address - Fax:407-286-7494
Practice Address - Street 1:36 S SEMORAN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3262
Practice Address - Country:US
Practice Address - Phone:407-601-7631
Practice Address - Fax:407-286-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X, 106S00000X
FLPY7320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty