Healthcare Provider Details

I. General information

NPI: 1609793405
Provider Name (Legal Business Name): INTERNATIONAL CENTER FOR AUTISM - TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MEMORIAL DR STE 200
DENISON TX
75020-2007
US

IV. Provider business mailing address

102 MEMORIAL DR STE 200
DENISON TX
75020-2007
US

V. Phone/Fax

Practice location:
  • Phone: 945-341-2512
  • Fax: 214-594-9769
Mailing address:
  • Phone: 945-341-2512
  • Fax: 214-594-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: STACEY REED
Title or Position: OWNER
Credential:
Phone: 945-341-2512