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NPI Code Detail

MEDICARE: ALYSSA R SMITH BCBA

MEDICARE: ALYSSA R SMITH BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-18-74244IN
2103K00000XBehavior Analyst1-25-81938IN

General Provider Information

NPI Number : 1013571066
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA R SMITH BCBA
Provider Business Mailing Address
First Line : 6131 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-4905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6131 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-4905
Country : US
Telephone Number : 260-459-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2019
Last Update Date : 06/24/2025

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Directions to “ ALYSSA R SMITH BCBA” Practice Location

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