Provider Demographics
NPI:1487457792
Name:PACK, CHRISSIE (RBT)
Entity type:Individual
Prefix:
First Name:CHRISSIE
Middle Name:
Last Name:PACK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2560
Mailing Address - Country:US
Mailing Address - Phone:812-580-4447
Mailing Address - Fax:
Practice Address - Street 1:404 E TANNER ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-2038
Practice Address - Country:US
Practice Address - Phone:812-569-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBACB1278254106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician