Healthcare Provider Details

I. General information

NPI: 1043954308
Provider Name (Legal Business Name): CENTER FOR AUTISM AND NEURODIVERSITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 09/11/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 S ATLANTA AVE
TULSA OK
74105
US

IV. Provider business mailing address

5310 S ATLANTA AVE
TULSA OK
74105-7204
US

V. Phone/Fax

Practice location:
  • Phone: 918-922-8152
  • Fax:
Mailing address:
  • Phone: 888-706-0552
  • Fax: 888-706-0552

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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA MARTIN
Title or Position: CEO, FOUNDER
Credential: BCBA, LBA
Phone: 918-607-3322