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General NPI Number Information
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NPI Number | 1932862257
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Entity Type | Individual
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Provider Name | LAURA MARIE KIRCH
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Gender | Female
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 7526 E 82ND STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 46256
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Country | US
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Telephone | 317-222-1886
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 N HOLLYWOOD WAY STE 102
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City | BURBANK
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State | CA
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Zip | 91505-5031
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Country | US
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Telephone | 866-727-8274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1-22-63119
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License Number State | IN
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