Provider Demographics
NPI:1396415451
Name:PLATT, CHARLES ANDREW (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:PLATT
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Other 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:317-520-8200
Practice Address - Street 1:3602 E GREENWAY RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4648
Practice Address - Country:US
Practice Address - Phone:602-560-2832
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-21-185063106S00000X
1-24-72441103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-24-72441OtherBCBA CERTIFICATE