Provider Demographics
NPI:1063799443
Name:AUTISM SPECTRUM AND DISABILITY SERVICES
Entity type:Organization
Organization Name:AUTISM SPECTRUM AND DISABILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA
Authorized Official - Phone:269-762-2075
Mailing Address - Street 1:7285 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:269-762-2076
Mailing Address - Fax:
Practice Address - Street 1:7285 BLUESTONE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:269-762-2076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-08-4678103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty