Provider Demographics
NPI:1598128175
Name:CHANGING LIVES BEHAVIOR ANALYSIS SERVICES INC
Entity type:Organization
Organization Name:CHANGING LIVES BEHAVIOR ANALYSIS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-454-3324
Mailing Address - Street 1:550 W 37TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-4004
Mailing Address - Country:US
Mailing Address - Phone:888-454-3324
Mailing Address - Fax:888-616-1634
Practice Address - Street 1:550 W 37TH ST STE A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4004
Practice Address - Country:US
Practice Address - Phone:888-454-3324
Practice Address - Fax:888-616-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty