Provider Demographics
NPI:1467997932
Name:AUTISM ASSESSMENT AND THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:AUTISM ASSESSMENT AND THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DON
Authorized Official - Last Name:BRINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-705-8664
Mailing Address - Street 1:378 E NAGANO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4302
Mailing Address - Country:US
Mailing Address - Phone:435-705-8664
Mailing Address - Fax:
Practice Address - Street 1:378 E NAGANO DR
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4302
Practice Address - Country:US
Practice Address - Phone:435-705-8664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7089681-3501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health