Provider Demographics
NPI:1275934622
Name:AUTISM CONTINUUM THERAPIES LLC
Entity Type:Organization
Organization Name:AUTISM CONTINUUM THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-241-6780
Mailing Address - Street 1:505 N BRAND BLVD
Mailing Address - Street 2:#1000
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1906
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:818-241-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-00-0010103K00000X
VA1-07-3957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-00-0010OtherBCBA-D