Provider Demographics
NPI:1013678986
Name:AYALA'S THERAPIST
Entity Type:Organization
Organization Name:AYALA'S THERAPIST
Other - Org Name:AUTISM BEHAVIOR SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:254-394-8181
Mailing Address - Street 1:7061 COMPASS BEND DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-9648
Mailing Address - Country:US
Mailing Address - Phone:254-394-8181
Mailing Address - Fax:
Practice Address - Street 1:445 E CHEYENNE MTN. BVLD, STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4570
Practice Address - Country:US
Practice Address - Phone:719-352-2970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-19-38385OtherABA