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General NPI Number Information
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NPI Number | 1649917394
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Entity Type | Organization
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Legal Business Name | ALPHA AUTISM THERAPY, LLC
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Dates
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Enumeration Date | 05/15/2022
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 2524 N BROADWAY SUITE 528
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City | EDMOND
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State | OK
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Zip | 73034
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Country | US
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Telephone | 405-987-7354
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Fax | 877-349-8962
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Provider Business Mailing Address
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Address Line | 2524 N BROADWAY SUITE 528
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City | EDMOND
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State | OK
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Zip | 73034
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Country | US
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Telephone | 405-987-7354
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Fax | 877-349-8962
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Authorized Official
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Title or Position | CEO
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Name | KATRINA GITTINS
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Credential | BCBA
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Telephone | 405-987-7354
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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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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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Taxonomy #3
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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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