Basic Information
| Provider Information | |||||||||
| NPI: | 1316404239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMACK | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10518 MADISON BROOKS DR | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460409419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179024826 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8402 E 116TH ST | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460381506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178027447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2019 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-18-33041 | IN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.