Healthcare Provider Details

I. General information

NPI: 1083584403
Provider Name (Legal Business Name): SMART START AUTISM THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 N 12TH ST
PHOENIX AZ
85022-2711
US

IV. Provider business mailing address

7037 N 2ND DR
PHOENIX AZ
85021-8701
US

V. Phone/Fax

Practice location:
  • Phone: 602-753-8443
  • Fax:
Mailing address:
  • Phone: 602-885-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND BROWN
Title or Position: PARTNER
Credential:
Phone: 602-885-7009