Healthcare Provider Details

I. General information

NPI: 1124930169
Provider Name (Legal Business Name): WONDER AUTISM THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N SHARY RD STE 1002
MISSION TX
78572-8235
US

IV. Provider business mailing address

210 N MOCKINGBIRD AVE
MISSION TX
78572-4764
US

V. Phone/Fax

Practice location:
  • Phone: 956-320-0881
  • Fax: 833-485-4697
Mailing address:
  • Phone: 956-320-0881
  • Fax: 833-485-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NELLY DE LA TORRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-320-0881