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NPI Code Detail

MEDICARE: ALYSSA R SMITH BCBA

MEDICARE: ALYSSA R SMITH BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-18-74244IN
2103K00000XBehavior Analyst1-25-81938IN

General Provider Information

NPI Number : 1013571066
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA R SMITH BCBA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 4422 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-6917
Country : US
Telephone Number : 260-471-9263
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2019
Last Update Date : 05/27/2026

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Directions to “ ALYSSA R SMITH BCBA” Practice Location

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