Provider Demographics
NPI:1407325145
Name:ASD SMART KIDS
Entity Type:Organization
Organization Name:ASD SMART KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARRAUTHERS.
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-412-6451
Mailing Address - Street 1:337 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1596
Mailing Address - Country:US
Mailing Address - Phone:313-412-6451
Mailing Address - Fax:
Practice Address - Street 1:337 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1596
Practice Address - Country:US
Practice Address - Phone:313-412-6451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASD SMART KIDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty