Provider Demographics
NPI:1326394107
Name:ABC AUTISM CONNECTION
Entity Type:Organization
Organization Name:ABC AUTISM CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:254-238-1130
Mailing Address - Street 1:4404 JAKE SPOON DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3118
Mailing Address - Country:US
Mailing Address - Phone:254-238-1130
Mailing Address - Fax:254-245-9535
Practice Address - Street 1:4404 JAKE SPOON DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3118
Practice Address - Country:US
Practice Address - Phone:254-238-1130
Practice Address - Fax:254-245-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-10256251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health