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General NPI Number Information
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NPI Number | 1255909578
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Entity Type | Organization
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Legal Business Name | PROPEL AUTISM LLC
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 260 PEACHTREE ST NW STE 2200
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City | ATLANTA
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State | GA
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Zip | 30303-1292
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Country | US
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Telephone | 803-316-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 DELAWARE DR
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City | DALZELL
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State | SC
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Zip | 29040-8975
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Country | US
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Telephone | 803-316-8387
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN LEWIS
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Credential |
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Telephone | 718-864-7291
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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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