Healthcare Provider Details

I. General information

NPI: 1053145557
Provider Name (Legal Business Name): ADAPT ABILITY AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S BROADWAY ST
ALBANY IN
47320-1717
US

IV. Provider business mailing address

148 S BROADWAY ST
ALBANY IN
47320-1717
US

V. Phone/Fax

Practice location:
  • Phone: 765-730-7883
  • Fax:
Mailing address:
  • Phone: 765-233-2536
  • 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: JESSIE VAUGHN
Title or Position: OWNER
Credential: BCBA
Phone: 765-233-2536