| Autism 360 Support Llc | |
|
5762 Bolsa Ave Ste 107 Huntington Beach CA 92649-1172 | |
| (562) 361-8578 | |
| Not Available |
| Full Name | Autism 360 Support Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5762 Bolsa Ave Ste 107, Huntington Beach, California |
| Authorized Official Name and Position | Ellen Jenny Slaton (OWNER) |
| Authorized Official Contact | 5623618578 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autism 360 Support Llc 11278 Los Alamitos Blvd # 106 Los Alamitos CA 90720-3958 Ph: (562) 396-5896 | Autism 360 Support Llc 5762 Bolsa Ave Ste 107 Huntington Beach CA 92649-1172 Ph: (562) 361-8578 |
| NPI Number | 1639802382 |
|---|---|
| Provider Enumeration Date | 07/08/2022 |
| Last Update Date | 01/26/2023 |
| Certification Date | 01/26/2023 |
| Medicare PECOS PAC ID | 4789057282 |
|---|---|
| Medicare Enrollment ID | O20230303001177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639802382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ellen Jenny Slaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023194438 PECOS PAC ID: 6507239001 Enrollment ID: I20230306001950 |
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