Provider Demographics
NPI:1386152700
Name:CAVENDER, ALICIA BUNCE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BUNCE
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:BUNCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:1300 E NEW CIRCLE ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-9001
Practice Address - Country:US
Practice Address - Phone:859-685-1019
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-28357OtherBCBA CERTIFICATE