Provider Demographics
NPI:1164029617
Name:LACUNA AUTISM SERVICES LLC
Entity type:Organization
Organization Name:LACUNA AUTISM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-463-6320
Mailing Address - Street 1:12846 MORNING BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4606
Mailing Address - Country:US
Mailing Address - Phone:719-529-0131
Mailing Address - Fax:
Practice Address - Street 1:10812 W MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5408
Practice Address - Country:US
Practice Address - Phone:719-529-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty