Individual
MOLLY DIANE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
450 S LANDMARK AVE, BLOOMINGTON, IN 47403-5000
(855) 324-0885
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-29564
IN
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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