Healthcare Provider Details

I. General information

NPI: 1003385410
Provider Name (Legal Business Name): KARYNTHIA TACHIANA LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W 84TH DR
MERRILLVILLE IN
46410-6243
US

IV. Provider business mailing address

14052 WHIPPLE ST
BLUE ISLAND IL
60406-3385
US

V. Phone/Fax

Practice location:
  • Phone: 219-295-3463
  • Fax: 317-520-8200
Mailing address:
  • Phone: 708-400-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76958
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: