MEDICARE: AUTISM AND BEHAVIOR SOLUTIONS, 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	BEVB10	AK

General Provider Information

NPI Number	:	1255704573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM AND BEHAVIOR SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1076 BADGER RD
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-5047
Country	:	US
Telephone Number	:	702-279-8679
Fax Number	:	907-385-0633

Provider Business Practice Location Address
First Line	:	1076 BADGER RD
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-5047
Country	:	US
Telephone Number	:	702-279-8679
Fax Number	:	907-385-0633

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JUDE N/A JENKINS-SCHRACK
Credential	:	BCBA
Telephone Number	:	702-279-8679

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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