Healthcare Provider Details

I. General information

NPI: 1215239967
Provider Name (Legal Business Name): MARISSA NICHOLE CLINE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 MERRILLVILLE RD
MERRILLVILLE IN
46410-6109
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 219-205-3463
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-824-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-21484
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number95001932A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: