Provider Demographics
NPI:1144924432
Name:AUTISMEVALS.COM
Entity type:Organization
Organization Name:AUTISMEVALS.COM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN LAEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LEP
Authorized Official - Phone:530-227-2883
Mailing Address - Street 1:5201 GREAT AMERICA PARKWAY
Mailing Address - Street 2:SUITE 320 #273
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054
Mailing Address - Country:US
Mailing Address - Phone:530-227-2883
Mailing Address - Fax:
Practice Address - Street 1:3400 COTTAGE WAY
Practice Address - Street 2:STE G2 #21123
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:530-227-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIOR ANALYST SUPERVISOR, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-29
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty