Provider Demographics
NPI:1235676990
Name:CIRCLE CITY ABA
Entity Type:Organization
Organization Name:CIRCLE CITY ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF STRATEGIC DEV.
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:COCHRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-502-3512
Mailing Address - Street 1:2785 CASON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2843
Mailing Address - Country:US
Mailing Address - Phone:317-502-3512
Mailing Address - Fax:
Practice Address - Street 1:2785 CASON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2843
Practice Address - Country:US
Practice Address - Phone:765-446-4185
Practice Address - Fax:855-915-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty