Basic Information
| Provider Information | |||||||||
| NPI: | 1063920684 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINK TO LEARN BEHAVIOR THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15151 DRY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460604615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656612613 | ||||||||
| FaxNumber: | 3172190727 | ||||||||
| Practice Location | |||||||||
| Address1: | 15151 DRY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460604615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656612613 | ||||||||
| FaxNumber: | 7656612613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | BATES | ||||||||
| AuthorizedOfficialFirstName: | RONSHAYA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR ANALYST / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7656612613 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.