Provider Demographics
NPI:1770839086
Name:TUSTIN AUTISM SERVICES FOR KIDS
Entity Type:Organization
Organization Name:TUSTIN AUTISM SERVICES FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POST
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC, SLP
Authorized Official - Phone:714-838-2115
Mailing Address - Street 1:661 W 1ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2939
Mailing Address - Country:US
Mailing Address - Phone:714-838-2115
Mailing Address - Fax:714-838-4533
Practice Address - Street 1:661 W 1ST ST STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2939
Practice Address - Country:US
Practice Address - Phone:714-838-2115
Practice Address - Fax:714-838-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5043261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty