Provider Demographics
NPI:1235788233
Name:TOLLISON, KIRA (BCBA)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:TOLLISON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
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:
Practice Address - Street 1:1900 INDIAN WOOD CIR STE 100
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4039
Practice Address - Country:US
Practice Address - Phone:419-830-0078
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OH1-23-67765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician