Provider Demographics
NPI:1194991778
Name:BEHAVIOR SPECIALISTS OF INDIANA, LLC
Entity type:Organization
Organization Name:BEHAVIOR SPECIALISTS OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-462-6705
Mailing Address - Street 1:2611A CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6111
Mailing Address - Country:US
Mailing Address - Phone:219-462-6705
Mailing Address - Fax:219-464-4318
Practice Address - Street 1:2611A CHICAGO ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6111
Practice Address - Country:US
Practice Address - Phone:219-462-6705
Practice Address - Fax:219-464-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041239251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200536380Medicaid
IN200650880Medicaid
IN200717130AMedicaid
IN200447720AMedicaid
IN200173830AMedicaid
IN200650880Medicaid