Provider Demographics
NPI: | 1376253716 |
---|---|
Name: | MINDCOLOR AUTISM LLC |
Entity Type: | Organization |
Organization Name: | MINDCOLOR AUTISM LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO-FOUNDER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HENG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 833-646-3222 |
Mailing Address - Street 1: | 224 W 35TH ST STE 500 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10001-2538 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 833-646-3222 |
Mailing Address - Fax: | 833-646-3222 |
Practice Address - Street 1: | 295 INTERLOCKEN BLVD STE 250 |
Practice Address - Street 2: | |
Practice Address - City: | BROOMFIELD |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80021-8040 |
Practice Address - Country: | US |
Practice Address - Phone: | 833-646-3222 |
Practice Address - Fax: | 833-646-3222 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-11-28 |
Last Update Date: | 2022-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty |