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General NPI Number Information
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NPI Number | 1568871390
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Entity Type | Organization
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Legal Business Name | WEST TEXAS AUTISM CENTER
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 4601 HARTFORD ST
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City | ABILENE
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State | TX
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Zip | 79605-4603
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Country | US
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Telephone | 325-669-6552
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Fax |
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Provider Business Mailing Address
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Address Line | 1326 S LEGGETT DR
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City | ABILENE
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State | TX
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Zip | 79605-3841
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Country | US
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Telephone | 325-669-6552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA RICHARDSON
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Credential | BCBA
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Telephone | 325-669-6552
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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 | 1-12-10325
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License Number State | TX
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