Provider Demographics
NPI:1437533049
Name:AUSOME KIDZ THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:AUSOME KIDZ THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTERWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:423-676-6317
Mailing Address - Street 1:1001 N ROAN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4669
Mailing Address - Country:US
Mailing Address - Phone:423-676-6317
Mailing Address - Fax:
Practice Address - Street 1:1001 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4669
Practice Address - Country:US
Practice Address - Phone:423-676-6317
Practice Address - Fax:866-468-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-17417261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities