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NPI Code Detail

MEDICARE: INDIGO THERAPY SERVICES LLC

MEDICARE: INDIGO THERAPY SERVICES LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1205524089
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDIGO THERAPY SERVICES LLC
Provider Business Mailing Address
First Line : 4900 OHEAR AVE STE 100
Second Line : #24
City : NORTH CHARLESTON
State : SC
Zip : 29405-5091
Country : US
Telephone Number : 917-362-3726
Fax Number :
Provider Business Practice Location Address
First Line : 4900 OHEAR AVE STE 100
Second Line : #24
City : NORTH CHARLESTON
State : SC
Zip : 29405-5091
Country : US
Telephone Number : 917-362-3726
Fax Number :
Authorized Official
Title or Position : BCBA/CFO
Name : MR. YASER KHALED JABER
Credential : M.A., BCBA, LBA
Telephone Number : 917-362-3726
Provider Enumeration Date : 04/28/2023
Last Update Date : 04/28/2023

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Directions to “INDIGO THERAPY SERVICES LLC ” Practice Location

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