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Organization
ORIGINS DEVELOPMENTAL LLC
Active
Organization
ORIGINS DEVELOPMENTAL LLC
Active
Other names
ORIGINS DEVELOPMENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
JASON SHAW MA, BCBA (CHIEF OPERATING OFFICER)
(260) 483-4988
Entity
Organization
Contact information
Practice address
4118 N CLINTON ST, FORT WAYNE, IN 46805-1210
(260) 483-4988
Mailing address
1824 TOUBY PIKE STE B, KOKOMO, IN 46901-2573
(765) 628-7400
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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