Healthcare Provider Details

I. General information

NPI: 1881141075
Provider Name (Legal Business Name): LUKE YEAGER B.A. RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 GRANT LINE RD STE 15
NEW ALBANY IN
47150
US

IV. Provider business mailing address

3211 GRANT LINE RD STE 15
NEW ALBANY IN
47150-2175
US

V. Phone/Fax

Practice location:
  • Phone: 502-417-9830
  • Fax: 866-859-3937
Mailing address:
  • Phone: 502-417-9830
  • Fax: 866-859-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1622045
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: