Provider Demographics
NPI:1720212749
Name:KYO AUTISM THERAPY, LLC
Entity Type:Organization
Organization Name:KYO AUTISM THERAPY, LLC
Other - Org Name:GATEWAY LEARNING GROUP, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVITIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-264-6747
Mailing Address - Street 1:295 89TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1656
Mailing Address - Country:US
Mailing Address - Phone:877-264-6747
Mailing Address - Fax:877-539-7730
Practice Address - Street 1:295 89TH ST STE 306
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1656
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:877-539-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1042076251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health