The Champion Center for Autism, Inc

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

THE CHAMPION CENTER FOR AUTISM, INC

Practice address

17500 Sycamore Ave
Country Club Hills, IL 60478-4884

Phone

(708) 213-7991

Fax

(708) 365-6765

NPI assigned

Jan 20, 2015

Organization subpart

No

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

Authorized official

Name

Latrice A Harrell

Title

Executive Director

Phone

(708) 213-7991

Specialties & licenses 10

Addresses

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

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    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1952790560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17500 SYCAMORE AVE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604784884",
            "telephone_number": "708-213-7991",
            "fax_number": "708-365-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17500 SYCAMORE AVE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604784884",
            "telephone_number": "708-213-7991",
            "fax_number": "708-365-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHAMPION CENTER FOR AUTISM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "LATRICE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-213-7991"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": null,
            "primary": false
        },
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            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": null,
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        },
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            "code": "225XF0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": "IL",
            "license": null,
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        },
        {
            "code": "225XR0403X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Driving and Community Mobility",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Country Club Hills, IL
• Providers in Country Club Hills, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.