Provider Demographics
NPI:1508589581
Name:ANDERSON AUTISM SERVICES, INC
Entity Type:Organization
Organization Name:ANDERSON AUTISM SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:SIOBHAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA
Authorized Official - Phone:504-427-8737
Mailing Address - Street 1:225 FRANKLIN RD UNIT 3214
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2746
Mailing Address - Country:US
Mailing Address - Phone:504-427-8737
Mailing Address - Fax:
Practice Address - Street 1:3355 LENOX RD NE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1353
Practice Address - Country:US
Practice Address - Phone:470-682-3536
Practice Address - Fax:470-682-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty