Individual
JACQUELINE RICHELLE THAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
12726 HAMILTON CROSSING BLVD, CARMEL, IN 46032-5422
(317) 249-2242
(317) 249-2248
Mailing address
3922 MEZZANINE DR, LAFAYETTE, IN 47905-8642
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-12-11897
IN
Other
Enumeration date
09/11/2013
Last updated
09/11/2013
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