Organization
NOVED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY EMMERT BCBA (OWNER)
(765) 366-1895
Entity
Organization
Contact information
Practice address
301 S LAZY LN, ROCKVILLE, IN 47872-7738
(765) 366-1895
Mailing address
5597 N LYE CREEK PKWY, CRAWFORDSVILLE, IN 47933-7831
(765) 366-1895
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300027503
—
IN
Enumeration date
08/27/2024
Last updated
08/27/2024
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