Healthcare Provider Details

I. General information

NPI: 1093527590
Provider Name (Legal Business Name): BETHANY FLICK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 STANLEY RD
PLAINFIELD IN
46168-8490
US

IV. Provider business mailing address

860 N LINCOLN ST APT 3
MARTINSVILLE IN
46151-1152
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-5501
  • Fax:
Mailing address:
  • Phone: 317-771-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: