Provider Demographics
NPI:1881864916
Name:AUTISM SERVICES NORTH
Entity Type:Organization
Organization Name:AUTISM SERVICES NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-241-6780
Mailing Address - Street 1:505 N. BRAND BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:855-295-3276
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:275 CUMBERLAND PARKWAY
Practice Address - Street 2:SUITE 316
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17005
Practice Address - Country:US
Practice Address - Phone:800-306-8602
Practice Address - Fax:818-241-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
1-00-0010103K00000X
1-04-1754103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty