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Organization
EARLY IMPACT LLC
Active
Organization
EARLY IMPACT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN HALL (OWNER)
(317) 319-7622
Entity
Organization
Contact information
Practice address
4243 STUBBINGTON LN, INDIANAPOLIS, IN 46239-1597
(317) 319-7622
Mailing address
4243 STUBBINGTON LN, INDIANAPOLIS, IN 46239-1597
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
NULL
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
NULL
106S00000X
Behavior Technician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
01/24/2022
Last updated
01/24/2022
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