Provider Demographics
NPI:1285170290
Name:AUTISM THERAPY SERVICES OF MOSES LAKE, LLC
Entity type:Organization
Organization Name:AUTISM THERAPY SERVICES OF MOSES LAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REIGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-764-6644
Mailing Address - Street 1:618 S ALDER ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1760
Mailing Address - Country:US
Mailing Address - Phone:509-764-6644
Mailing Address - Fax:509-764-6676
Practice Address - Street 1:618 S ALDER ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1760
Practice Address - Country:US
Practice Address - Phone:509-764-6644
Practice Address - Fax:509-764-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604002137251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health