Provider Demographics
NPI:1982727848
Name:INDIANA BEHAVIORAL SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:INDIANA BEHAVIORAL SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAROLYN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:317-581-1082
Mailing Address - Street 1:9221 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1020
Mailing Address - Country:US
Mailing Address - Phone:317-581-1082
Mailing Address - Fax:317-705-1410
Practice Address - Street 1:9221 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1020
Practice Address - Country:US
Practice Address - Phone:317-581-1082
Practice Address - Fax:317-705-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty