Provider Demographics
NPI:1720554652
Name:LINVILLE, AUDREY K (BCBA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:K
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 HAMILTON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5400
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:317-663-1175
Practice Address - Street 1:12650 HAMILTON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5400
Practice Address - Country:US
Practice Address - Phone:317-249-2242
Practice Address - Fax:317-663-1175
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst