Healthcare Provider Details

I. General information

NPI: 1851134605
Provider Name (Legal Business Name): ELITE BEHAVIORAL SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 CRAIG ST STE 330
INDIANAPOLIS IN
46250-3541
US

IV. Provider business mailing address

8383 CRAIG ST STE 330
INDIANAPOLIS IN
46250-3541
US

V. Phone/Fax

Practice location:
  • Phone: 317-513-1846
  • Fax: 877-200-8921
Mailing address:
  • Phone: 317-513-1846
  • Fax: 877-200-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL BROWN
Title or Position: OWNER
Credential:
Phone: 317-513-1846