Healthcare Provider Details

I. General information

NPI: 1922553056
Provider Name (Legal Business Name): INDIGO KIDS BEHAVIORAL LEARNING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N SEMORAN BLVD STE 200
ORLANDO FL
32807-3567
US

IV. Provider business mailing address

1300 N SEMORAN BLVD STE 200
ORLANDO FL
32807-3567
US

V. Phone/Fax

Practice location:
  • Phone: 321-890-4038
  • Fax:
Mailing address:
  • Phone: 321-890-4038
  • Fax: 321-234-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-16-22688
License Number StateCO

VIII. Authorized Official

Name: STEPHANIE MARIE FORD
Title or Position: OWNER/BEHAVIOR ANALYST
Credential: B.C.B.A
Phone: 321-890-4038