Healthcare Provider Details

I. General information

NPI: 1902616444
Provider Name (Legal Business Name): HALEY ELIZABETH LAMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY ELIZABETH JOHNSON

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N FULTON AVE
EVANSVILLE IN
47710-1034
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 812-202-6001
  • Fax:
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2827202
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: