Healthcare Provider Details

I. General information

NPI: 1598589525
Provider Name (Legal Business Name): HOPE HARBOR AUTISM SUPPORT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W GOLF RD STE 18
ARLINGTON HEIGHTS IL
60005-3923
US

IV. Provider business mailing address

415 W GOLF RD STE 18
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 847-637-5334
  • Fax: 847-637-5334
Mailing address:
  • Phone: 847-637-5334
  • Fax: 847-637-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER DEAN WATSON
Title or Position: PRESIDENT/OWNER
Credential: PSY.D.
Phone: 847-208-7808