MEDICARE: COLORADO AUTISM CONSULTANTS, LLC

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205460029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO AUTISM CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4804
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-4804
Country	:	US
Telephone Number	:	800-536-2340
Fax Number	:	303-957-2251

Provider Business Practice Location Address
First Line	:	613 E MAIN ST
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-2213
Country	:	US
Telephone Number	:	720-548-8055
Fax Number	:	303-957-2251

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ABIGAIL KOENIG
Credential	:	BCBA
Telephone Number	:	970-433-8339

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	11/01/2023

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