Provider Demographics
NPI:1316771090
Name:NOVED
Entity type:Organization
Organization Name:NOVED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:765-366-1895
Mailing Address - Street 1:5597 N LYE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-7831
Mailing Address - Country:US
Mailing Address - Phone:765-366-1895
Mailing Address - Fax:
Practice Address - Street 1:301 S LAZY LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-7738
Practice Address - Country:US
Practice Address - Phone:765-366-1895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300027503Medicaid