Healthcare Provider Details

I. General information

NPI: 1073156402
Provider Name (Legal Business Name): JOELLE ANTONIA OPYT MS., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8398 MISSISSIPPI ST
MERRILLVILLE IN
46410-6316
US

IV. Provider business mailing address

184 CRESTVIEW LN
DYER IN
46311-4610
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-1048
  • Fax: 219-769-1048
Mailing address:
  • Phone: 219-765-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63017
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: