Healthcare Provider Details

I. General information

NPI: 1801481106
Provider Name (Legal Business Name): STEP AHEAD ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST FL SQUARE16
INDIANAPOLIS IN
46204-1904
US

IV. Provider business mailing address

201 N ILLINOIS ST FL 16
INDIANAPOLIS IN
46204-1904
US

V. Phone/Fax

Practice location:
  • Phone: 216-407-3651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JAY LEVIN
Title or Position: MANAGER
Credential:
Phone: 317-296-7730