Provider Demographics
NPI:1992267397
Name:ADVANCEMENT PEDIATRIC AUTISM THERAPY LLC
Entity type:Organization
Organization Name:ADVANCEMENT PEDIATRIC AUTISM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ BEHAVIOR CONSULATANT
Authorized Official - Prefix:
Authorized Official - First Name:DEVONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-719-5086
Mailing Address - Street 1:1575 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2428
Mailing Address - Country:US
Mailing Address - Phone:231-719-5086
Mailing Address - Fax:
Practice Address - Street 1:1575 6TH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2428
Practice Address - Country:US
Practice Address - Phone:231-719-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health