Provider Demographics
NPI:1609305978
Name:AUTISM COACHING, CONSULTING, AND TRAINING, LLC
Entity Type:Organization
Organization Name:AUTISM COACHING, CONSULTING, AND TRAINING, LLC
Other - Org Name:AUTISM COACHING, CONSULTING, AND TRAINING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:KH
Authorized Official - Last Name:MIRAMONTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:206-930-7116
Mailing Address - Street 1:676 LOVELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2714
Mailing Address - Country:US
Mailing Address - Phone:206-930-7116
Mailing Address - Fax:
Practice Address - Street 1:676 LOVELL AVE NW
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-930-7116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604-132-315OtherUBI