Provider Demographics
NPI:1336408822
Name:AUTISM MOVEMENT THERAPY, INC.
Entity Type:Organization
Organization Name:AUTISM MOVEMENT THERAPY, INC.
Other - Org Name:AUTISM MOVEMENT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-240-0361
Mailing Address - Street 1:7439 ORION AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3319
Mailing Address - Country:US
Mailing Address - Phone:323-240-0361
Mailing Address - Fax:866-498-2702
Practice Address - Street 1:7439 ORION AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3319
Practice Address - Country:US
Practice Address - Phone:323-240-0361
Practice Address - Fax:866-498-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty