Provider Demographics
NPI:1104198944
Name:ROURKE, ERIN MCELROY (MBA, BCBA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MCELROY
Last Name:ROURKE
Suffix:
Gender:F
Credentials:MBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:9302 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-7342
Practice Address - Country:US
Practice Address - Phone:520-278-5758
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000069103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-11-8889OtherBCBA CERTIFICATE