Provider Demographics
NPI:1245699719
Name:MERCHANT, CLARISSA RUTH (MED, BCBA)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:RUTH
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:RUTH
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, BCABA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:11450 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4688
Practice Address - Country:US
Practice Address - Phone:317-689-7850
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33833103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33833OtherBCBA CERTIFICATE