Healthcare Provider Details

I. General information

NPI: 1215471149
Provider Name (Legal Business Name): AUTISM SPECTRUM SUPPORT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 W 5TH ST FL 26
LOS ANGELES CA
90071-2053
US

IV. Provider business mailing address

633 W 5TH ST FL 26
LOS ANGELES CA
90071-2053
US

V. Phone/Fax

Practice location:
  • Phone: 888-725-7087
  • Fax:
Mailing address:
  • Phone: 888-725-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES CHULJOO RHEE
Title or Position: EXECUTIVE DIRECTOR
Credential: MST, M. ED, DBH
Phone: 888-725-7087