Provider Demographics
NPI:1881101426
Name:ADAMS, JAN
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2240
Mailing Address - Country:US
Mailing Address - Phone:765-587-4895
Mailing Address - Fax:765-452-5207
Practice Address - Street 1:1714 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2240
Practice Address - Country:US
Practice Address - Phone:765-587-4895
Practice Address - Fax:765-452-5207
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-17-28547103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst