Provider Demographics
NPI:1477125953
Name:WICHMAN, COTY L (BCBA)
Entity Type:Individual
Prefix:
First Name:COTY
Middle Name:L
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:COTY
Other - Middle Name:L
Other - Last Name:HUEBSCHMAN
Other - Suffix:
Other - Last Name Type:Former 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 1:4655 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9366
Practice Address - Country:US
Practice Address - Phone:812-213-8031
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-22-62255103K00000X
INRBT-21-175323106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician