Healthcare Provider Details

I. General information

NPI: 1942005228
Provider Name (Legal Business Name): CREID AYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 S A ST
RICHMOND IN
47374-6055
US

IV. Provider business mailing address

215 RED COACH DR
MISHAWAKA IN
46545-8307
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-4313
  • Fax: 574-204-2868
Mailing address:
  • Phone: 574-387-4313
  • Fax: 574-204-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82637
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-264461
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: