Provider Demographics
NPI:1942589619
Name:BEHAVIOR ANALYSIS CENTER FOR AUTISM
Entity type:Organization
Organization Name:BEHAVIOR ANALYSIS CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-576-8548
Mailing Address - Street 1:11902 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1308
Mailing Address - Country:US
Mailing Address - Phone:317-288-5232
Mailing Address - Fax:317-288-5229
Practice Address - Street 1:11902 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1308
Practice Address - Country:US
Practice Address - Phone:317-288-5232
Practice Address - Fax:317-288-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty