Provider Demographics
NPI:1023601986
Name:KIDDOS FIRST AUTISM THERAPY
Entity type:Organization
Organization Name:KIDDOS FIRST AUTISM THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIOR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TALISSA
Authorized Official - Middle Name:LECINUE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:813-557-9128
Mailing Address - Street 1:510 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4536
Mailing Address - Country:US
Mailing Address - Phone:813-557-9128
Mailing Address - Fax:
Practice Address - Street 1:5006 TROUBLE CREEK RD STE 218
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4939
Practice Address - Country:US
Practice Address - Phone:813-557-9128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health