Provider Demographics
NPI:1780958025
Name:BEHAVIORAL AUTISM THERAPIES, LLC
Entity type:Organization
Organization Name:BEHAVIORAL AUTISM THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:626-893-5046
Mailing Address - Street 1:20926 BLACK STALLION DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3849
Mailing Address - Country:US
Mailing Address - Phone:626-893-5046
Mailing Address - Fax:626-502-1178
Practice Address - Street 1:20926 BLACK STALLION DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3849
Practice Address - Country:US
Practice Address - Phone:626-893-5046
Practice Address - Fax:626-502-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8431251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health