Provider Demographics
NPI:1396422689
Name:AUTISM TREATMENT PROFESSIONALS LLC
Entity type:Organization
Organization Name:AUTISM TREATMENT PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:214-789-1387
Mailing Address - Street 1:2920 HUDSON BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4758
Mailing Address - Country:US
Mailing Address - Phone:214-789-1387
Mailing Address - Fax:
Practice Address - Street 1:400 W CAPITOL AVE STE 1700
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3438
Practice Address - Country:US
Practice Address - Phone:214-789-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty