Provider Demographics
NPI:1750150942
Name:SOUTHWEST AUTISM RESEARCH AND RESOURCE CENTER
Entity type:Organization
Organization Name:SOUTHWEST AUTISM RESEARCH AND RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-218-8211
Mailing Address - Street 1:2225 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1823
Mailing Address - Country:US
Mailing Address - Phone:602-340-8717
Mailing Address - Fax:602-340-8720
Practice Address - Street 1:2225 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1823
Practice Address - Country:US
Practice Address - Phone:602-340-8717
Practice Address - Fax:602-340-8720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST AUTISM RESEARCH AND RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty