Provider Demographics
NPI:1629386156
Name:HOPE CENTER 4 AUTISM FORT WORTH
Entity Type:Organization
Organization Name:HOPE CENTER 4 AUTISM FORT WORTH
Other - Org Name:HOPE CENTER FOR AUTISM FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LANETTE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-560-1109
Mailing Address - Street 1:2751 GREEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1706
Mailing Address - Country:US
Mailing Address - Phone:817-560-1139
Mailing Address - Fax:817-560-7039
Practice Address - Street 1:2751 GREEN OAKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1706
Practice Address - Country:US
Practice Address - Phone:817-560-1139
Practice Address - Fax:817-560-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty