Organization Name: | AUTISM ASSISTANCE & THERAPY CENTER, INC. |
NPI Number: | 1043595564 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JORDAN LAUBE (EXECUTIVE DIRECTOR) |
Mailing Address: | 370 Liberty Heights Dr Chaska |
State: | MN US |
Postal Code: | 553184607 |
Phone Number: | 9524486161 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2011 |
NPI Last Update Date: | 10/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 5121 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |