Healthcare Provider Details

I. General information

NPI: 1205658341
Provider Name (Legal Business Name): LACUNA AUTISM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 RESEARCH PKWY UNIT A
COLORADO SPRINGS CO
80920-1038
US

IV. Provider business mailing address

830 TENDERFOOT HILL RD STE 100
COLORADO SPRINGS CO
80906-7372
US

V. Phone/Fax

Practice location:
  • Phone: 888-611-0870
  • Fax: 888-714-4996
Mailing address:
  • Phone:
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CREAGER
Title or Position: PRESIDENT
Credential:
Phone: 888-611-0870