Provider Demographics
NPI:1710202171
Name:DISABILITY AND AUTISM SERVICES OF INDIANA LLC
Entity Type:Organization
Organization Name:DISABILITY AND AUTISM SERVICES OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIBBYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:812-322-4374
Mailing Address - Street 1:4561 W COUNTY ROAD 650 N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:IN
Mailing Address - Zip Code:47272-9742
Mailing Address - Country:US
Mailing Address - Phone:812-322-4374
Mailing Address - Fax:
Practice Address - Street 1:4561 W COUNTY ROAD 650 N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:IN
Practice Address - Zip Code:47272-9742
Practice Address - Country:US
Practice Address - Phone:812-322-4374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-08-4008103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty