Healthcare Provider Details

I. General information

NPI: 1619594645
Provider Name (Legal Business Name): MIAH LOREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 FOUNDERS RD
INDIANAPOLIS IN
46268-1338
US

IV. Provider business mailing address

8741 FOUNDERS RD
INDIANAPOLIS IN
46268-1338
US

V. Phone/Fax

Practice location:
  • Phone: 317-452-9430
  • Fax:
Mailing address:
  • Phone: 317-452-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87307
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: