Provider Demographics
NPI:1386985992
Name:AUTISM DIAGNOSTIC & SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:AUTISM DIAGNOSTIC & SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA & DIAGNOSTICIAN
Authorized Official - Phone:409-622-9796
Mailing Address - Street 1:280 COUNTY ROAD 4111
Mailing Address - Street 2:PO BOX 193
Mailing Address - City:CALL
Mailing Address - State:TX
Mailing Address - Zip Code:75933-4618
Mailing Address - Country:US
Mailing Address - Phone:409-622-9796
Mailing Address - Fax:409-420-0678
Practice Address - Street 1:280 COUNTY ROAD 4111
Practice Address - Street 2:
Practice Address - City:CALL
Practice Address - State:TX
Practice Address - Zip Code:75933-4618
Practice Address - Country:US
Practice Address - Phone:409-622-9796
Practice Address - Fax:409-420-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11312866251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health