Healthcare Provider Details

I. General information

NPI: 1326356239
Provider Name (Legal Business Name): AUTISM LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 29TH ST
MONROE LA
71201-3704
US

IV. Provider business mailing address

810 N 29TH ST
MONROE LA
71201-3704
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1223
  • Fax: 318-323-1224
Mailing address:
  • Phone: 318-323-1223
  • Fax: 318-323-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number497870
License Number StateLA

VIII. Authorized Official

Name: MS. LISA GILLEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 318-323-1223