Healthcare Provider Details

I. General information

NPI: 1760196745
Provider Name (Legal Business Name): DEVOTED AUTISM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10262 LUNETH DR
COLORADO SPRINGS CO
80925-1470
US

IV. Provider business mailing address

10262 LUNETH DR
COLORADO SPRINGS CO
80925-1470
US

V. Phone/Fax

Practice location:
  • Phone: 252-402-0513
  • Fax:
Mailing address:
  • Phone: 252-402-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA VOGT
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: MA, BCBA
Phone: 252-402-0513