Provider Demographics
NPI:1376778415
Name:CHILDREN'S AUTISM CENTER
Entity Type:Organization
Organization Name:CHILDREN'S AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:512-733-2800
Mailing Address - Street 1:1707 N MAYS ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2914
Mailing Address - Country:US
Mailing Address - Phone:512-733-2800
Mailing Address - Fax:
Practice Address - Street 1:1707 N MAYS ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2914
Practice Address - Country:US
Practice Address - Phone:512-733-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health