Provider Demographics
NPI:1275032096
Name:PIECE BY PIECE AUTISM CENTER
Entity Type:Organization
Organization Name:PIECE BY PIECE AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:MEGHANN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:765-430-8285
Mailing Address - Street 1:6373 DUSTY LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9727
Mailing Address - Country:US
Mailing Address - Phone:765-430-8285
Mailing Address - Fax:
Practice Address - Street 1:602 RANSDELL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2349
Practice Address - Country:US
Practice Address - Phone:765-430-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-16-24128251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health