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General NPI Number Information
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NPI Number | 1205524089
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Entity Type | Organization
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Legal Business Name | INDIGO THERAPY SERVICES LLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 4900 OHEAR AVE STE 100 #24
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-5091
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Country | US
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Telephone | 917-362-3726
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 OHEAR AVE STE 100 #24
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-5091
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Country | US
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Telephone | 917-362-3726
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Fax |
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Authorized Official
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Title or Position | BCBA/CFO
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Name | MR. YASER KHALED JABER
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Credential | M.A., BCBA, LBA
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Telephone | 917-362-3726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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