Provider Demographics
NPI:1699034066
Name:AUTISM TREATMENT GROUP, LLC
Entity Type:Organization
Organization Name:AUTISM TREATMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-576-8548
Mailing Address - Street 1:11650 LANTERN RD STE 230
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3099
Mailing Address - Country:US
Mailing Address - Phone:317-576-8548
Mailing Address - Fax:
Practice Address - Street 1:11650 LANTERN RD STE 230
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3099
Practice Address - Country:US
Practice Address - Phone:317-576-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty