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NPI Code Detail

MEDICARE: CIRCLE CITY ABA

MEDICARE: CIRCLE CITY ABA
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 Technician

General Provider Information

NPI Number : 1780515296
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIRCLE CITY ABA
Provider Business Mailing Address
First Line : 5915 S EMERSON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-1971
Country : US
Telephone Number : 317-759-3240
Fax Number :
Provider Business Practice Location Address
First Line : 5915 S EMERSON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-1971
Country : US
Telephone Number : 317-759-3240
Fax Number :
Authorized Official
Title or Position : BEHAVIOR TECHNICIAN
Name : SHANAE GATEWOOD
Credential :
Telephone Number : 463-401-3118
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “CIRCLE CITY ABA ” Practice Location

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