Provider Demographics
NPI:1104507383
Name:PAIR TREE AUTISM SERVICES LLC
Entity type:Organization
Organization Name:PAIR TREE AUTISM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:SHALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-240-8188
Mailing Address - Street 1:3449 W STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ROYAL CENTER
Mailing Address - State:IN
Mailing Address - Zip Code:46978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3449 W STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:ROYAL CENTER
Practice Address - State:IN
Practice Address - Zip Code:46978
Practice Address - Country:US
Practice Address - Phone:574-240-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty