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NPI Code Detail

MEDICARE: AUTISTIC TREATMENT CENTER, INC.

MEDICARE: AUTISTIC TREATMENT CENTER, INC.
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1083765960
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTISTIC TREATMENT CENTER, INC.
Provider Business Mailing Address
First Line : 10503 METRIC DR
Second Line :
City : DALLAS
State : TX
Zip : 75243-5514
Country : US
Telephone Number : 972-644-2076
Fax Number : 972-644-5650
Provider Business Practice Location Address
First Line : 10503 METRIC DR
Second Line :
City : DALLAS
State : TX
Zip : 75243-5514
Country : US
Telephone Number : 972-644-2076
Fax Number : 972-644-5650
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. ANNA PENN HUNDLEY
Credential :
Telephone Number : 972-644-2076
Provider Enumeration Date : 01/16/2007
Last Update Date : 04/30/2012

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