Provider Demographics
NPI:1174364053
Name:DORING, MARRISSA (BCBA)
Entity type:Individual
Prefix:
First Name:MARRISSA
Middle Name:
Last Name:DORING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 W 2ND ST STE D
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3277
Mailing Address - Country:US
Mailing Address - Phone:812-481-8141
Mailing Address - Fax:
Practice Address - Street 1:690 W 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3277
Practice Address - Country:US
Practice Address - Phone:812-481-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN1-25-80027103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician