Provider Demographics
NPI:1922565910
Name:TOLLY, ALYSSA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TOLLY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9929 E 126TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9404
Mailing Address - Country:US
Mailing Address - Phone:317-436-8961
Mailing Address - Fax:317-991-1593
Practice Address - Street 1:9929 E 126TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-9404
Practice Address - Country:US
Practice Address - Phone:317-436-8961
Practice Address - Fax:317-991-1593
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst