MEDICARE: HOUSTON AUTISM CENTER

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	103TS0200X	School Psychologist
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1649516139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON AUTISM CENTER

Provider Business Mailing Address
First Line	:	5246 DOW RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5246 DOW RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6202
Country	:	US
Telephone Number	:	713-939-1229
Fax Number	:	713-939-1569

Authorized Official
Title or Position	:	CHIEF OF OPERATIONS
Name	:	MR. JORGE HERNANDO CARRILLO JR.
Credential	:
Telephone Number	:	713-939-1229

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	02/28/2022

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Directions to “HOUSTON AUTISM CENTER ” Practice Location

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