Healthcare Provider Details

I. General information

NPI: 1619893724
Provider Name (Legal Business Name): MOMENTUM BEHAVIOR CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8133 FAWNSBROOK DR
FISHERS IN
46038-1028
US

IV. Provider business mailing address

8133 FAWNSBROOK DR
FISHERS IN
46038-1028
US

V. Phone/Fax

Practice location:
  • Phone: 765-426-4993
  • Fax:
Mailing address:
  • Phone: 765-426-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER R HERCEG
Title or Position: CEO
Credential: MSW
Phone: 765-426-4993