Provider Demographics
NPI:1679062277
Name:PARKER, ALLISON ELIZA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ELIZA
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ELIZA
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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 1:2513 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3241
Practice Address - Country:US
Practice Address - Phone:765-662-0490
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-17-35255106S00000X
1-19-37201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1-19-37201OtherBEHAVIOR ANALYST CERTIFICATION BOARD
IN300031519Medicaid