Provider Demographics
NPI:1336730944
Name:PINNACLE AUTISM THERAPY
Entity Type:Organization
Organization Name:PINNACLE AUTISM THERAPY
Other - Org Name:PINNACLE AUTISM THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OOSHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-342-8847
Mailing Address - Street 1:20860 N TATUM BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4285
Mailing Address - Country:US
Mailing Address - Phone:866-342-8847
Mailing Address - Fax:
Practice Address - Street 1:5 W MENDENHALL ST STE 202
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3566
Practice Address - Country:US
Practice Address - Phone:866-342-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health