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General NPI Number Information
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NPI Number | 1043571334
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Entity Type | Organization
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Legal Business Name | AUTISM ADVANTAGE, LLP.
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Dates
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Enumeration Date | 06/03/2012
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Last Update Date | 06/03/2012
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Provider Practice Location Address
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Address Line | 1004 W 31ST ST
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City | AUSTIN
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State | TX
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Zip | 78705-2002
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Country | US
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Telephone | 512-650-8639
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 W 31ST ST
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City | AUSTIN
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State | TX
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Zip | 78705-2002
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Country | US
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Telephone | 512-650-8639
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Fax |
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Authorized Official
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Title or Position | OWNER/ PSYCHOLOGIST
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Name | DR. CHRIS SMITH
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Credential | PHD
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Telephone | 512-650-8639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3727
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 33891
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License Number State | TX
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