MEDICARE: SUMMIT AUTISM SERVICES

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

General Provider Information

NPI Number	:	1730312976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT AUTISM SERVICES

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD
Second Line	:	#2717
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 N RAINBOW BLVD
Second Line	:	#2717
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	361-850-0580
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. JAMIE M HUGHES
Credential	:
Telephone Number	:	361-850-0580

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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Directions to “SUMMIT AUTISM SERVICES ” Practice Location

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