Provider Demographics
NPI:1609359819
Name:FAIRCHILD, MINDY JOAN (BCBA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JOAN
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:JOAN
Other - Last Name:SPANGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 COMMERCIAL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8805
Mailing Address - Country:US
Mailing Address - Phone:765-628-7400
Mailing Address - Fax:
Practice Address - Street 1:80 COMMERCIAL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8805
Practice Address - Country:US
Practice Address - Phone:260-200-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-31167103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst