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General NPI Number Information
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NPI Number | 1821598269
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Entity Type | Organization
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Legal Business Name | AUTISM SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 808 RIDGEWAY AVE
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City | MORGANTOWN
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State | WV
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Zip | 26505-5748
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Country | US
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Telephone | 412-607-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 808 RIDGEWAY AVE
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City | MORGANTOWN
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State | WV
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Zip | 26505-5748
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Country | US
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Telephone | 412-607-4142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLAUDIA NEELY
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Credential | BCBA,
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Telephone | 412-607-4142
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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 | 15-20152
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License Number State | WV
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