Healthcare Provider Details

I. General information

NPI: 1629712211
Provider Name (Legal Business Name): JACOB BRIGHT BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W JEFFERSON ST
FRANKLIN IN
46131-9120
US

IV. Provider business mailing address

11979 FISHERS CROSSING DR
FISHERS IN
46038-2778
US

V. Phone/Fax

Practice location:
  • Phone: 317-918-2689
  • Fax: 317-973-0196
Mailing address:
  • Phone: 317-918-2689
  • Fax: 317-973-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-106221
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60103
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: