=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336442698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WITHIN REACH - CENTER FOR AUTISM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2010
-----------------------------------------------------
Last Update Date | 06/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 DEMOSTHENES ST
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-885-4327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 DEMOSTHENES ST
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-885-4327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/BCBA
-----------------------------------------------------
Name | EMILY HULL BELLACI
-----------------------------------------------------
Credential | BCBA, LBA
-----------------------------------------------------
Telephone | 504-885-4327
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-10-7522
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------