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General NPI Number Information
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NPI Number | 1558881656
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Entity Type | Organization
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Legal Business Name | CHIPOLA AREA AUTISM RESOURCE CENTER, INC.
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5865 NEALS LANDING RD
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City | BASCOM
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State | FL
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Zip | 32423-9213
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Country | US
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Telephone | 850-272-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 4438 DAVIS ST
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City | MARIANNA
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State | FL
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Zip | 32446-3125
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Country | US
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Telephone | 850-272-6099
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANN MARIE SHELTON
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Credential | BCBA
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Telephone | 850-272-6099
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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 | 1-16-23058
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License Number State | FL
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