Provider Demographics
NPI:1952013427
Name:DAVIS, ALLISON (BCBA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DAVIS
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 1:225 GASLITE LN
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1012
Mailing Address - Country:US
Mailing Address - Phone:317-364-2885
Mailing Address - Fax:
Practice Address - Street 1:5999 W MEMORY LN
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7294
Practice Address - Country:US
Practice Address - Phone:317-477-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1487684494Medicaid