Provider Demographics
NPI:1962879544
Name:AUTISM AND DEVELOPMENTAL INTERVENTION SERVICES
Entity type:Organization
Organization Name:AUTISM AND DEVELOPMENTAL INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-472-3660
Mailing Address - Street 1:23259 JOAQUIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23259 JOAQUIN RIDGE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3208
Practice Address - Country:US
Practice Address - Phone:714-472-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty