Provider Demographics
NPI:1962064998
Name:THE AUTISM COLLABORATIVE GROUP
Entity type:Organization
Organization Name:THE AUTISM COLLABORATIVE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:RAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:714-337-6484
Mailing Address - Street 1:12777 VALLEY VIEW ST STE 121
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2521
Mailing Address - Country:US
Mailing Address - Phone:714-337-6484
Mailing Address - Fax:714-894-6140
Practice Address - Street 1:12777 VALLEY VIEW ST STE 121
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2521
Practice Address - Country:US
Practice Address - Phone:714-337-6484
Practice Address - Fax:855-213-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-29
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty