Provider Demographics
NPI:1104600816
Name:ATLAS BEHAVIOR ANALYSIS
Entity type:Organization
Organization Name:ATLAS BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISTON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:435-225-2103
Mailing Address - Street 1:11751 CHELSEA CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1511
Mailing Address - Country:US
Mailing Address - Phone:435-225-2103
Mailing Address - Fax:
Practice Address - Street 1:11751 CHELSEA CT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1511
Practice Address - Country:US
Practice Address - Phone:435-225-2103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health