Mountainside Autism Therapy, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

MOUNTAINSIDE AUTISM THERAPY, LLC

Practice address

305 Morning Dew CT
Canton, GA 30114-5121

Phone

(678) 740-3742

NPI assigned

Jul 6, 2021

Organization subpart

No

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

Authorized official

Name

Eric Shults, BCBA

Title

Owner

Phone

(678) 738-3077

Specialties & licenses 1

Addresses

Other names 1

• Mountainside Autism Therapy, LLC Former legal business name

Electronic endpoints 1

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1982275574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 MORNING DEW CT",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145121",
            "telephone_number": "678-740-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 MORNING DEW CT",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145121",
            "telephone_number": "678-740-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE AUTISM THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-06",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "SHULTS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-738-3077",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Canton",
            "affiliation": "N",
            "endpointDescription": "In home office computer",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "305 Morning Dew Ct",
            "city": "Canton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301145121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mountainside Autism Therapy, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Behavior Analyst in Canton, GA
• Providers in Canton, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.