MEDICARE: COLLABORATIVE AUTISM RESOURCES AND EDUCATION

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	103K00000X	Behavior Analyst	LLC9373-2002	NV

General Provider Information

NPI Number	:	1225338460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATIVE AUTISM RESOURCES AND EDUCATION

Provider Business Mailing Address
First Line	:	8722 CEDARWOOD LN
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-2136
Country	:	US
Telephone Number	:	877-712-2735
Fax Number	:	702-924-2561

Provider Business Practice Location Address
First Line	:	14419 CYPRESS FALLS DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-1998
Country	:	US
Telephone Number	:	877-712-2735
Fax Number	:	702-924-2561

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MS. TONI VENTRELLA
Credential	:
Telephone Number	:	877-712-2735

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	07/03/2013

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