Provider Demographics
NPI:1386232023
Name:INDY ANGELLS BEHAVIOR CONSULTING LLC
Entity Type:Organization
Organization Name:INDY ANGELLS BEHAVIOR CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:317-296-5088
Mailing Address - Street 1:8520 ALLISON POINTE BLVD, STE 223
Mailing Address - Street 2:PMB 69818
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4299
Mailing Address - Country:US
Mailing Address - Phone:317-296-5088
Mailing Address - Fax:
Practice Address - Street 1:2309 S CAMERON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5701
Practice Address - Country:US
Practice Address - Phone:317-296-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty