=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588573315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LACUNA AUTISM SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2026
-----------------------------------------------------
Last Update Date | 09/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3325 N ACADEMY BLVD
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80917-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-611-0870
-----------------------------------------------------
Fax | 888-714-4996
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 TENDERFOOT HILL RD
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80906-2314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-611-0870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NATIONAL REVENUE CYCLE MANAGER
-----------------------------------------------------
Name | SAYDRA STARKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-611-0870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------