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General NPI Number Information
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NPI Number | 1770303570
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Entity Type | Organization
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Legal Business Name | THE IVORY ACADEMY AUTISM CENTER LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 4590 OLD TOWN RD
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City | WHITESBORO
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State | TX
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Zip | 76273-7418
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Country | US
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Telephone | 903-818-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 4590 OLD TOWN RD
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City | WHITESBORO
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State | TX
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Zip | 76273-7418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | DEVYN POWER
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Credential | M.ED., BCBA, LBA
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Telephone | 903-718-9913
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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