Provider Demographics
NPI:1245326792
Name:EALY, LINA R (BCBA)
Entity type:Individual
Prefix:MS
First Name:LINA
Middle Name:R
Last Name:EALY
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 1:5856 CEDARSTONE COURT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226
Mailing Address - Country:US
Mailing Address - Phone:317-450-0795
Mailing Address - Fax:866-612-2996
Practice Address - Street 1:5856 CEDARSTONE COURT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226
Practice Address - Country:US
Practice Address - Phone:317-450-0795
Practice Address - Fax:866-612-2996
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist