Healthcare Provider Details

I. General information

NPI: 1609194000
Provider Name (Legal Business Name): AUTISM SPECTRUM THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 N HOLLYWOOD WAY STE 301
BURBANK CA
91505-5025
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY STE 301
BURBANK CA
91505-5025
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax: 800-459-4245
Mailing address:
  • Phone: 866-727-8274
  • Fax: 747-220-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HAUPT
Title or Position: EXECUTIVE VP, AUTISM SERVICES
Credential:
Phone: 866-727-8274