| A Leap Beyond Autism Services, Llc | |
|
110 Newfield Dr Tyrone GA 30290-2567 | |
| (678) 862-6226 | |
| Not Available |
| Full Name | A Leap Beyond Autism Services, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 110 Newfield Dr, Tyrone, Georgia |
| Authorized Official Name and Position | Tia Chalise Penn-tabor (CEO) |
| Authorized Official Contact | 4049663933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Leap Beyond Autism Services, Llc 100 Commerce Dr Unit 452 Tyrone GA 30290-8020 Ph: (404) 966-3933 | A Leap Beyond Autism Services, Llc 110 Newfield Dr Tyrone GA 30290-2567 Ph: (678) 862-6226 |
| NPI Number | 1417524307 |
|---|---|
| Provider Enumeration Date | 06/08/2021 |
| Last Update Date | 10/06/2022 |
| Certification Date | 10/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417524307 | NPI | - | NPPES |
| 8837997616 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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