Provider Demographics
NPI:1811370208
Name:THE SPECTRUM CENTER FOR AUTISM
Entity Type:Organization
Organization Name:THE SPECTRUM CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ABREE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:308-455-9411
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0492
Mailing Address - Country:US
Mailing Address - Phone:308-455-9411
Mailing Address - Fax:
Practice Address - Street 1:1708 E 46TH STREET PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2696
Practice Address - Country:US
Practice Address - Phone:308-455-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty