=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528958758
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENE HARRELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2025
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4830 W 200 N
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46750-9005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-388-6414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 TICE BLVD
-----------------------------------------------------
City | WOODCLIFF LAKE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07677-8406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------