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Individual

MARTIN DOUGLAS MYERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
BCBA

Contact information

Practice address
4422 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 471-9263
(765) 450-6664
Mailing address
P.O. BOX 3070, 3500 DEPAUW BOULEVARD, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(765) 450-6664

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1-15-18339
BCBA BOARD CERTIFICATION
Enumeration date
05/01/2015
Last updated
12/08/2017
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