Healthcare Provider Details

I. General information

NPI: 1316700677
Provider Name (Legal Business Name): GUIDANCE PEDIATRICS AND AUTISM SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6657 W COUNTY ROAD 900 N
BRAZIL IN
47834-7952
US

IV. Provider business mailing address

8465 KEYSTONE CROSSING SUITE 115 #1201
INDIANAPOLIS IN
46240
US

V. Phone/Fax

Practice location:
  • Phone: 812-239-6293
  • Fax:
Mailing address:
  • Phone: 812-239-6293
  • 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 Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA PETROWSKI
Title or Position: OWNER
Credential:
Phone: 812-239-6293