Healthcare Provider Details

I. General information

NPI: 1427594902
Provider Name (Legal Business Name): AUTISM TREATMENT CENTER ABA SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

IV. Provider business mailing address

15911 NACOGDOCHES RD
SAN ANTONIO TX
78247-1107
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-7733
  • Fax: 210-599-3105
Mailing address:
  • Phone: 210-599-7733
  • Fax: 210-599-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS EMILY DAWN PASCHAL
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 210-599-7733