Provider Demographics
NPI:1396227070
Name:BEHAVIORAL SERVICES FOR AUTISM, INC
Entity Type:Organization
Organization Name:BEHAVIORAL SERVICES FOR AUTISM, INC
Other - Org Name:BEHAVIORAL AND COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRINGTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:REGISTERED BEHAVIOR
Authorized Official - Phone:815-277-9505
Mailing Address - Street 1:1095 PINGREE ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:815-277-9505
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-277-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty