Healthcare Provider Details

I. General information

NPI: 1396458634
Provider Name (Legal Business Name): PUZZLE PIECE AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10013 SUNNY SIDE LN SIDE
TEMPLE TX
76502-5370
US

IV. Provider business mailing address

10013 SUNNY SIDE LN SIDE
TEMPLE TX
76502-5370
US

V. Phone/Fax

Practice location:
  • Phone: 337-378-2077
  • Fax:
Mailing address:
  • Phone: 337-378-2077
  • 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: JAMETHA MUMFORD
Title or Position: OWNER
Credential:
Phone: 337-378-2077