Provider Demographics
NPI:1699472290
Name:PETERS, GABRIELLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:355 QUARTERMASTER CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3670
Practice Address - Country:US
Practice Address - Phone:812-258-9802
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-23-63849103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1-23-63849OtherBOARD CERTIFIED BEHAVIOR ANALYST