Provider Demographics
NPI:1164285839
Name:AXIS FOR AUTISM, LLC
Entity Type:Organization
Organization Name:AXIS FOR AUTISM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-888-8882
Mailing Address - Street 1:1645 E MISSOURI AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3035
Mailing Address - Country:US
Mailing Address - Phone:602-413-5397
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 420
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2472
Practice Address - Country:US
Practice Address - Phone:602-888-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty