Basic Information
| Provider Information | |||||||||
| NPI: | 1740792308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUTISM BEHAVIOR SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2080 N TUSTIN AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927057875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495810100 | ||||||||
| FaxNumber: | 8553293973 | ||||||||
| Practice Location | |||||||||
| Address1: | 2080 N TUSTIN AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927057875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495810100 | ||||||||
| FaxNumber: | 8553293973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2017 | ||||||||
| LastUpdateDate: | 11/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | PATTERSON | ||||||||
| AuthorizedOfficialFirstName: | ROSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8555810100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY. D, BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-27503 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.