Provider Demographics
NPI:1710389317
Name:TEXAS TECH UNIVERSITY
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY
Other - Org Name:BURKHART CENTER FOR AUTISM EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-834-0783
Mailing Address - Street 1:PO BOX 41071
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79409-1071
Mailing Address - Country:US
Mailing Address - Phone:806-834-0783
Mailing Address - Fax:806-742-2179
Practice Address - Street 1:2902 18TH STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409
Practice Address - Country:US
Practice Address - Phone:806-834-0783
Practice Address - Fax:806-742-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty