Healthcare Provider Details

I. General information

NPI: 1700367604
Provider Name (Legal Business Name): LILINE NELSON BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILINE NELSON MA

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 FOWLER ST
ANDERSON IN
46012-3713
US

IV. Provider business mailing address

2513 FOWLER ST
ANDERSON IN
46012-3713
US

V. Phone/Fax

Practice location:
  • Phone: 765-256-0392
  • Fax:
Mailing address:
  • Phone: 765-256-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: