MEDICARE: CHANGE IT ABA 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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578048658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGE IT ABA LLC

Provider Business Mailing Address
First Line	:	PO BOX 2419
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46018-2419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5051 GREENSIDE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-6140
Country	:	US
Telephone Number	:	317-362-7287
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RASHAI REYNOLDS
Credential	:	MAE, MA, BCBA
Telephone Number	:	317-362-7287

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	03/15/2024

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Directions to “CHANGE IT ABA LLC ” Practice Location

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