Healthcare Provider Details

I. General information

NPI: 1427625565
Provider Name (Legal Business Name): MARIAH HURLEY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 01/07/2025
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E SOUTHERN AVE
INDIANAPOLIS IN
46203
US

IV. Provider business mailing address

1061 E SOUTHERN AVE
INDIANAPOLIS IN
46203
US

V. Phone/Fax

Practice location:
  • Phone: 463-701-0909
  • Fax: 844-742-6592
Mailing address:
  • Phone: 317-914-3176
  • Fax: 844-742-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75543
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: