Healthcare Provider Details

I. General information

NPI: 1386232023
Provider Name (Legal Business Name): INDY ANGELLS BEHAVIOR CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 S CAMERON AVE
TAMPA FL
33629-5701
US

IV. Provider business mailing address

8520 ALLISON POINTE BLVD, STE 223 PMB 69818
INDIANAPOLIS IN
46250-4299
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-5088
  • Fax:
Mailing address:
  • Phone: 317-296-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: AMY ANGELL
Title or Position: OWNER, BCBA
Credential: BCBA
Phone: 317-296-5088