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General NPI Number Information
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NPI Number | 1023601986
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Entity Type | Organization
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Legal Business Name | KIDDOS FIRST AUTISM THERAPY
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 5006 TROUBLE CREEK RD STE 218
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4939
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Country | US
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Telephone | 813-557-9128
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Fax |
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Provider Business Mailing Address
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Address Line | 510 E MORGAN ST
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4536
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Country | US
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Telephone | 813-557-9128
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Fax |
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Authorized Official
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Title or Position | REGISTERED BEHAVIOR TECHNICIAN
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Name | TALISSA LECINUE COX
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Credential | RBT
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Telephone | 813-557-9128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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