Provider Demographics
NPI:1255751863
Name:AUTISM SPECTRUM INSTRUCTIONAL RESOURCES
Entity type:Organization
Organization Name:AUTISM SPECTRUM INSTRUCTIONAL RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CAYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHPALL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:858-449-3463
Mailing Address - Street 1:4415 AVENUE B APT 104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3629
Mailing Address - Country:US
Mailing Address - Phone:858-449-3463
Mailing Address - Fax:
Practice Address - Street 1:13405 SADDLE BACK PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6149
Practice Address - Country:US
Practice Address - Phone:512-423-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-15555103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty