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General NPI Number Information
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NPI Number | 1164029617
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Entity Type | Organization
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Legal Business Name | LACUNA AUTISM SERVICES LLC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 10812 W MONTE VISTA RD
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City | AVONDALE
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State | AZ
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Zip | 85392-5408
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Country | US
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Telephone | 719-529-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 12846 MORNING BREEZE WAY
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City | PEYTON
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State | CO
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Zip | 80831-4606
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Country | US
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Telephone | 719-529-0131
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MEAGAN MCCURDY
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Credential |
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Telephone | 407-463-6320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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