| NPI | 1982275574 |
|---|---|
| Former Legal Business Name | MOUNTAINSIDE AUTISM THERAPY, LLC |
| Entity Type | Organization |
| Authorized Contact | ERIC SHULTS Owner 678-738-3077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2021-07-06 |