Basic Information
| Provider Information | |||||||||
| NPI: | 1336791920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOALS FOR AUTISM, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5940 S RAINBOW BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891182506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885318385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5940 S RAINBOW BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891182506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885318385 | ||||||||
| FaxNumber: | 9252641902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | KETCHAM | ||||||||
| AuthorizedOfficialFirstName: | ADRYON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4159159408 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.