Provider Demographics
NPI:1619286754
Name:INDIANA APPLIED BEHAVIOR ANALYSIS INSTITUTE
Entity Type:Organization
Organization Name:INDIANA APPLIED BEHAVIOR ANALYSIS INSTITUTE
Other - Org Name:INDIANA ABA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:260-479-0295
Mailing Address - Street 1:PO BOX 10343
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46851-0343
Mailing Address - Country:US
Mailing Address - Phone:260-479-0295
Mailing Address - Fax:
Practice Address - Street 1:2415 HOAGLAND AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-1333
Practice Address - Country:US
Practice Address - Phone:888-667-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty