Healthcare Provider Details

I. General information

NPI: 1649917394
Provider Name (Legal Business Name): ALPHA AUTISM THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 N BROADWAY SUITE 528
EDMOND OK
73034
US

IV. Provider business mailing address

2524 N BROADWAY SUITE 528
EDMOND OK
73034
US

V. Phone/Fax

Practice location:
  • Phone: 405-987-7354
  • Fax: 877-349-8962
Mailing address:
  • Phone: 405-987-7354
  • Fax: 877-349-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KATRINA GITTINS
Title or Position: CEO
Credential: BCBA
Phone: 405-987-7354