Provider Demographics
NPI:1205524089
Name:INDIGO THERAPY SERVICES LLC
Entity type:Organization
Organization Name:INDIGO THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:YASER
Authorized Official - Middle Name:KHALED
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LBA
Authorized Official - Phone:917-362-3726
Mailing Address - Street 1:4900 OHEAR AVE STE 100
Mailing Address - Street 2:#24
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5091
Mailing Address - Country:US
Mailing Address - Phone:917-362-3726
Mailing Address - Fax:
Practice Address - Street 1:4900 OHEAR AVE STE 100
Practice Address - Street 2:#24
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5091
Practice Address - Country:US
Practice Address - Phone:917-362-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty