MEDICARE: AUTISM SUPPORT NOW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1033636956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM SUPPORT NOW, LLC

Provider Business Mailing Address
First Line	:	4721 S CLIFF AVE STE 103
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-608-1956
Fax Number	:	800-687-5070

Provider Business Practice Location Address
First Line	:	4721 S CLIFF AVE STE 103
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-608-1956
Fax Number	:	800-687-5070

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MICHELLE DOUGLAS
Credential	:
Telephone Number	:	816-608-1958

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	01/28/2026

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