Provider Demographics
NPI:1063783298
Name:AUTISM SOLUTIONS OF GRANBURY, LLC
Entity type:Organization
Organization Name:AUTISM SOLUTIONS OF GRANBURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HARRINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BCABA
Authorized Official - Phone:817-894-7469
Mailing Address - Street 1:1540 SOUTHTOWN DR STE 113
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1540 SOUTHTOWN DR STE 113
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2667
Practice Address - Country:US
Practice Address - Phone:817-894-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0114050103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty