Provider Demographics
NPI:1093533028
Name:ATARAXY BEHAVIORAL SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:ATARAXY BEHAVIORAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBENSPECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-606-0154
Mailing Address - Street 1:10481 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IN
Mailing Address - Zip Code:47456-8560
Mailing Address - Country:US
Mailing Address - Phone:317-606-0154
Mailing Address - Fax:
Practice Address - Street 1:10481 TOWER RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IN
Practice Address - Zip Code:47456-8560
Practice Address - Country:US
Practice Address - Phone:317-606-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty