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General NPI Number Information
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NPI Number | 1124488879
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Entity Type | Organization
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Legal Business Name | AUTISM PERSONAL COACH
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 1258 BEACH AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2117
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Country | US
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Telephone | 216-215-6805
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Fax |
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Provider Business Mailing Address
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Address Line | 1258 BEACH AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2117
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Country | US
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Telephone | 216-215-6805
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. DOUG BLECHER
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Credential | PYSCHOLOGIST
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Telephone | 216-336-5889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | SP. 7093
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License Number State | OH
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