Provider Demographics
NPI:1023730512
Name:AUTRY BEHAVIORAL CONSULTANTS & RESOURCES
Entity type:Organization
Organization Name:AUTRY BEHAVIORAL CONSULTANTS & RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTRY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:910-583-4817
Mailing Address - Street 1:330 WEDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5010
Mailing Address - Country:US
Mailing Address - Phone:910-583-4817
Mailing Address - Fax:910-500-0603
Practice Address - Street 1:330 WEDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5010
Practice Address - Country:US
Practice Address - Phone:910-583-4817
Practice Address - Fax:910-500-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency