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General NPI Number Information
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NPI Number | 1639730294
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Entity Type | Organization
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Legal Business Name | TRI-CITY AUTISM CENTER, LLC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 1711 E CENTRAL TEXAS EXPY STE 304
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City | KILLEEN
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State | TX
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Zip | 76541-9147
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Country | US
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Telephone | 254-265-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 LUXOR DR
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City | KILLEEN
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State | TX
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Zip | 76549-4594
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Country | US
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Telephone | 254-265-6200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MEGHAN NAUCK
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Credential | BCBA
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Telephone | 254-265-6200
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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 |
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License Number State |
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