MEDICARE: FATHER'S LOVE BEHAVIORAL SOLUTIONS LLC

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1730714361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATHER'S LOVE BEHAVIORAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	4310 ROLLING SPRINGS DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-3769
Country	:	US
Telephone Number	:	317-397-7520
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 ROLLING SPRINGS DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-3769
Country	:	US
Telephone Number	:	317-937-5191
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RANDY DUANE ROBINSON II
Credential	:
Telephone Number	:	317-397-7520

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/04/2020

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