Healthcare Provider Details

I. General information

NPI: 1073422952
Provider Name (Legal Business Name): TEXAS AUTISM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13625 RONALD W REAGAN BLVD BLDG 1
CEDAR PARK TX
78613-2073
US

IV. Provider business mailing address

21111 N 9TH PL
PHOENIX AZ
85024-5636
US

V. Phone/Fax

Practice location:
  • Phone: 602-726-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SUMMER BURTON
Title or Position: SR. CREDENTIALING SPECIALIST
Credential:
Phone: 480-673-7174