MEDICARE: PINNACLE AUTISM SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871115287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE AUTISM SERVICES, LLC

Provider Business Mailing Address
First Line	:	400 W PEACHTREE ST NW UNIT 5168
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3536
Country	:	US
Telephone Number	:	678-886-4173
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W PEACHTREE ST NW UNIT 5168
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3536
Country	:	US
Telephone Number	:	678-886-4173
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY WHEELER
Credential	:	BCBA
Telephone Number	:	678-992-3097

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	05/08/2020

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Directions to “PINNACLE AUTISM SERVICES, LLC ” Practice Location

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