Healthcare Provider Details

I. General information

NPI: 1235861089
Provider Name (Legal Business Name): AUTISM INTERNATIONAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 MERRY MILL DR
SPRING TX
77386-4812
US

IV. Provider business mailing address

23838 SINGLE OAK ST
SPRING TX
77373-2307
US

V. Phone/Fax

Practice location:
  • Phone: 713-302-3439
  • Fax:
Mailing address:
  • Phone: 713-302-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE YVONNE WALLS
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 713-302-3439