Provider Demographics
NPI:1639708894
Name:INSPRED BY AUTISM LLC
Entity Type:Organization
Organization Name:INSPRED BY AUTISM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-445-0023
Mailing Address - Street 1:1006 INTREPID CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2415
Mailing Address - Country:US
Mailing Address - Phone:562-445-0023
Mailing Address - Fax:757-788-8636
Practice Address - Street 1:2019 CUNNINGHAM DR STE 105
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3316
Practice Address - Country:US
Practice Address - Phone:562-445-0023
Practice Address - Fax:757-788-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty