Provider Demographics
NPI:1134486855
Name:CHATTANOOGA AUTISM CENTER
Entity Type:Organization
Organization Name:CHATTANOOGA AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-260-1115
Mailing Address - Street 1:4445 WELLESLEY DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4887
Mailing Address - Country:US
Mailing Address - Phone:423-260-1115
Mailing Address - Fax:423-752-5299
Practice Address - Street 1:3097 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3089
Practice Address - Country:US
Practice Address - Phone:423-260-1115
Practice Address - Fax:423-752-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000044791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty