MEDICARE: MS. MICHELLE HENNESSEE SEARS 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
1	103K00000X	Behavior Analyst	1-18-33723	IN

General Provider Information

NPI Number	:	1881042885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE HENNESSEE SEARS BCBA

Provider Business Mailing Address
First Line	:	8328 MASTERS RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1538
Country	:	US
Telephone Number	:	317-436-7080
Fax Number	:	317-436-7225

Provider Business Practice Location Address
First Line	:	8328 MASTERS RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1538
Country	:	US
Telephone Number	:	317-436-7080
Fax Number	:	317-436-7225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	12/26/2018

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