Provider Demographics
NPI:1922708478
Name:ATLAS AUTISM HEALTH MISSOURI LLC
Entity Type:Organization
Organization Name:ATLAS AUTISM HEALTH MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABISHEK
Authorized Official - Middle Name:
Authorized Official - Last Name:THIAGARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-943-8811
Mailing Address - Street 1:800 CHERRY ST LOWR SUITES
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4824
Mailing Address - Country:US
Mailing Address - Phone:573-200-6745
Mailing Address - Fax:
Practice Address - Street 1:800 CHERRY ST LOWR SUITES
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4824
Practice Address - Country:US
Practice Address - Phone:573-200-6745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities