Healthcare Provider Details

I. General information

NPI: 1588827398
Provider Name (Legal Business Name): AUTISM LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY D NOBLES
Title or Position: OWNER
Credential:
Phone: 318-323-1223