MEDICARE: BEYOND THE LABEL AUTISM 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1902441017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND THE LABEL AUTISM SERVICES LLC

Provider Business Mailing Address
First Line	:	1800 W 900 S
Second Line	:
City	:	FLAT ROCK
State	:	IN
Zip	:	47234-9773
Country	:	US
Telephone Number	:	317-512-3063
Fax Number	:	317-663-2947

Provider Business Practice Location Address
First Line	:	1800 W 900 S
Second Line	:
City	:	FLAT ROCK
State	:	IN
Zip	:	47234-9773
Country	:	US
Telephone Number	:	317-512-3063
Fax Number	:	317-663-2947

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MELISSA JOY POE
Credential	:	BCBA
Telephone Number	:	317-512-3063

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	11/12/2019

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Directions to “BEYOND THE LABEL AUTISM SERVICES LLC ” Practice Location

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