=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912722372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARC AUTISM SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1021 COUNTRY CLUB RD UNIT A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213-2484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-407-3572
-----------------------------------------------------
Fax | 614-340-2922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1021 COUNTRY CLUB RD UNIT A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213-2484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-407-3572
-----------------------------------------------------
Fax | 614-340-2922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF SERVICES OFFICER
-----------------------------------------------------
Name | AMANDA SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-479-2513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------