Provider Demographics
NPI:1275922304
Name:LOVELL, CHRISTA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:LOVELL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 GALBURGH CT S
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1593
Mailing Address - Country:US
Mailing Address - Phone:317-696-7710
Mailing Address - Fax:
Practice Address - Street 1:11902 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1308
Practice Address - Country:US
Practice Address - Phone:317-288-5232
Practice Address - Fax:317-288-5229
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-14-17182103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst