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General NPI Number Information
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NPI Number | 1528541398
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Entity Type | Organization
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Legal Business Name | THE STEPPING STONES AUTISM GROUP, LLC
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 225 SAN MATTEO ST
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City | GEORGETOWN
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State | TX
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Zip | 78628-7032
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Country | US
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Telephone | 805-791-4219
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Fax |
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Provider Business Mailing Address
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Address Line | 4880 MARKET ST
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City | VENTURA
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State | CA
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Zip | 93003-7783
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Country | US
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Telephone | 805-915-9912
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | DOUGLAS R MOES
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Credential | PH.D.
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Telephone | 805-915-9912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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