MEDICARE: CENTER FOR AUTISM AND RELATED DISORDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	16-24356

General Provider Information

NPI Number	:	1083165773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR AUTISM AND RELATED DISORDERS

Provider Business Mailing Address
First Line	:	74 N PECOS RD
Second Line	:	SUITE C
City	:	HENDERSON
State	:	NV
Zip	:	89074-7343
Country	:	US
Telephone Number	:	702-778-4500
Fax Number	:	818-758-8015

Provider Business Practice Location Address
First Line	:	21600 OXNARD ST
Second Line	:	SUITE 1800
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	818-758-8015

Authorized Official
Title or Position	:	BEHAVIOR TECHNICIAN
Name	:	HANNAH MCCALLSON
Credential	:
Telephone Number	:	818-345-2345

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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