Healthcare Provider Details

I. General information

NPI: 1144924432
Provider Name (Legal Business Name): AUTISMEVALS.COM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 COTTAGE WAY STE G2 #21123
SACRAMENTO CA
95825
US

IV. Provider business mailing address

5201 GREAT AMERICA PARKWAY SUITE 320 #273
SANTA CLARA CA
95054
US

V. Phone/Fax

Practice location:
  • Phone: 530-227-2883
  • Fax:
Mailing address:
  • Phone: 530-227-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN VAN LAEKEN
Title or Position: OWNER
Credential: M.S., BCBA, LEP
Phone: 530-227-2883