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NPI Code Detail

MEDICARE: LACUNA AUTISM SERVICES LLC

MEDICARE: LACUNA AUTISM SERVICES 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1942809124
Entity Type Code : Organization
Provider Name (Legal Business Name) : LACUNA AUTISM SERVICES LLC
Provider Business Mailing Address
First Line : 12000 NETWORK BLVD STE 210
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-3353
Country : US
Telephone Number : 888-611-0870
Fax Number :
Provider Business Practice Location Address
First Line : 17319 SAN PEDRO AVE STE 510
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78232-1444
Country : US
Telephone Number : 719-529-0131
Fax Number :
Authorized Official
Title or Position : BOARD CERTIFIED BEHAVIOR ANALYST
Name : ASHLEY MORAN
Credential :
Telephone Number : 888-611-0870
Provider Enumeration Date : 10/20/2020
Last Update Date : 05/18/2026

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Directions to “LACUNA AUTISM SERVICES LLC ” Practice Location

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