Provider Demographics
NPI:1821827866
Name:INNER LIGHT ABA & BEHAVIORAL CONSULTING LLC
Entity type:Organization
Organization Name:INNER LIGHT ABA & BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:419-231-2088
Mailing Address - Street 1:12170 ROAD A
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9045
Mailing Address - Country:US
Mailing Address - Phone:419-231-2088
Mailing Address - Fax:
Practice Address - Street 1:12170 ROAD A
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-9045
Practice Address - Country:US
Practice Address - Phone:419-231-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty