| Mountainside Autism Therapy, Llc | |
|
305 Morning Dew Ct Canton GA 30114-5121 | |
| (678) 740-3742 | |
| Not Available |
| Full Name | Mountainside Autism Therapy, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 305 Morning Dew Ct, Canton, Georgia |
| Authorized Official Name and Position | Eric Shults (OWNER) |
| Authorized Official Contact | 6787383077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountainside Autism Therapy, Llc 305 Morning Dew Ct Canton GA 30114-5121 Ph: (678) 740-3742 | Mountainside Autism Therapy, Llc 305 Morning Dew Ct Canton GA 30114-5121 Ph: (678) 740-3742 |
| NPI Number | 1982275574 |
|---|---|
| Provider Enumeration Date | 07/06/2021 |
| Last Update Date | 07/06/2021 |
| Certification Date | 07/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982275574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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