Provider Demographics
NPI:1316404239
Name:CARMACK, MEREDITH LYN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:LYN
Last Name:CARMACK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10518 MADISON BROOKS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9419
Mailing Address - Country:US
Mailing Address - Phone:317-902-4826
Mailing Address - Fax:
Practice Address - Street 1:8402 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1506
Practice Address - Country:US
Practice Address - Phone:317-802-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-33041103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst