Healthcare Provider Details

I. General information

NPI: 1508462276
Provider Name (Legal Business Name): AUTISM BEHAVIOR CONSULTANTS OF THE WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 VALLEY VIEW DR SW
LOS LUNAS NM
87031-6143
US

IV. Provider business mailing address

1118 VALLEY VIEW DR SW
LOS LUNAS NM
87031-6143
US

V. Phone/Fax

Practice location:
  • Phone: 505-728-9885
  • Fax:
Mailing address:
  • Phone: 505-728-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ROSSLER
Title or Position: CEO
Credential: M.S., CCC-SLP
Phone: 505-728-9885