Provider Demographics
NPI:1588945885
Name:AUTISM BEHAVIOR ASSOCIATES, INC
Entity type:Organization
Organization Name:AUTISM BEHAVIOR ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:719-571-9830
Mailing Address - Street 1:1235 LAKE PLAZA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3556
Mailing Address - Country:US
Mailing Address - Phone:719-571-9830
Mailing Address - Fax:719-694-9122
Practice Address - Street 1:1235 LAKE PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3556
Practice Address - Country:US
Practice Address - Phone:719-571-9830
Practice Address - Fax:719-694-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities