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General NPI Number Information
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NPI Number | 1780958025
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL AUTISM THERAPIES, LLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 20926 BLACK STALLION DR
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City | COVINA
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State | CA
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Zip | 91724-3849
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Country | US
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Telephone | 626-893-5046
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Fax | 626-502-1178
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Provider Business Mailing Address
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Address Line | 20926 BLACK STALLION DR
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City | COVINA
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State | CA
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Zip | 91724-3849
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Country | US
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Telephone | 626-893-5046
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Fax | 626-502-1178
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. LARRY HUMPHREYS
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Credential | BCBA
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Telephone | 626-893-5046
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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 | 1-11-8431
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License Number State | CA
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