Basic Information
| Provider Information | |||||||||
| NPI: | 1275857450 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL TEXAS AUTISM CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL TEXAS AUTISM CENTER, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3006 BEE CAVES RD STE B200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787466751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123285599 | ||||||||
| FaxNumber: | 5123285585 | ||||||||
| Practice Location | |||||||||
| Address1: | 3006 BEE CAVES RD STE B200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787466751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123285599 | ||||||||
| FaxNumber: | 5123285585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2010 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | CUEVAS | ||||||||
| AuthorizedOfficialFirstName: | ONEYDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5123285599 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1096329 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1053472035 | 01 | NPPES | OTHER |