Provider Demographics
NPI:1902293939
Name:AUTISM ASSESSMENT TREATMENT PROGRAM CHILD
Entity Type:Organization
Organization Name:AUTISM ASSESSMENT TREATMENT PROGRAM CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TREADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-8110
Mailing Address - Street 1:650 S KOMAS DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 S KOMAS DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-581-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-16
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty