Healthcare Provider Details

I. General information

NPI: 1922718683
Provider Name (Legal Business Name): PHOENIX AUTISM CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E MCDOWELL RD STE 175
PHOENIX AZ
85008-7725
US

IV. Provider business mailing address

3303 N 44TH ST
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-0444
  • Fax: 602-854-7422
Mailing address:
  • Phone: 480-478-0444
  • Fax: 602-854-7422

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
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BREANNE MAE HARTMAN
Title or Position: OWNER
Credential:
Phone: 480-510-8323