Provider Demographics
NPI:1689936197
Name:AUTISM COLLABORATIVE THERAPIES
Entity Type:Organization
Organization Name:AUTISM COLLABORATIVE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-356-2755
Mailing Address - Street 1:3292 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3535
Mailing Address - Country:US
Mailing Address - Phone:510-356-2755
Mailing Address - Fax:510-356-2755
Practice Address - Street 1:3292 JORDAN RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3535
Practice Address - Country:US
Practice Address - Phone:510-356-2755
Practice Address - Fax:510-356-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty