Provider Demographics
NPI:1053688812
Name:ALLIED BEHAVIORAL CONSULTANTS
Entity Type:Organization
Organization Name:ALLIED BEHAVIORAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CAS LMHC LCAC
Authorized Official - Phone:317-847-1645
Mailing Address - Street 1:104 GRANBY DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2893
Mailing Address - Country:US
Mailing Address - Phone:317-847-1645
Mailing Address - Fax:
Practice Address - Street 1:104 GRANBY DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:IN
Practice Address - Zip Code:46229-2893
Practice Address - Country:US
Practice Address - Phone:317-847-1645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001215A101YA0400X
IN39000930A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty