Healthcare Provider Details

I. General information

NPI: 1609500420
Provider Name (Legal Business Name): SUNSHINE ABA THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2022
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 S LANDMARK AVE
BLOOMINGTON IN
47403-5004
US

IV. Provider business mailing address

443 S LANDMARK AVE
BLOOMINGTON IN
47403-5004
US

V. Phone/Fax

Practice location:
  • Phone: 317-523-2480
  • Fax:
Mailing address:
  • Phone:
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY LEHMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 317-400-9271