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General NPI Number Information
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NPI Number | 1154889459
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Entity Type | Organization
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Legal Business Name | TRAC AUTISM CENTER INC.
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 10751 S SAGINAW ST STE E
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City | GRAND BLANC
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State | MI
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Zip | 48439-8169
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Country | US
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Telephone | 586-404-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 3290 W BIG BEAVER RD STE 510
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City | TROY
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State | MI
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Zip | 48084-2917
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Country | US
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Telephone | 586-404-9400
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LISA GILLETTE
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Credential |
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Telephone | 989-513-0782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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Taxonomy #7
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #10
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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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Taxonomy #11
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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Taxonomy #12
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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