Collins Lake Autism Center

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

COLLINS LAKE AUTISM CENTER

Practice address

246 Encinal Road
Cleveland, NM 87715

Phone

(281) 630-0827

NPI assigned

Jun 18, 2013

Last updated

Jun 18, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephen Andrew Smaby

Title

Founder

Phone

(281) 630-0827

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1568801017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 GILDERSLEEVE ST",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875052636",
            "telephone_number": "281-630-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 ENCINAL ROAD",
            "city": "CLEVELAND",
            "state": "NM",
            "postal_code": "87715",
            "telephone_number": "281-630-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINS LAKE AUTISM CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-18",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "SMABY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "281-630-0827"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Gray
• Julianna Tarak Mustafa
• John Michael Tourangeau, LCSW, LADAC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Cleveland, NM
• Providers in Cleveland, NM by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.