Individual
TREVA E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
12938 COLDWATER RD, FORT WAYNE, IN 46845-9517
(317) 815-5501
Mailing address
101 E COOPER CT, ELLETTSVILLE, IN 47429-1616
(812) 319-7649
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
11520991
IN
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-20991
BCBS CERTIFICATE #
—
Enumeration date
02/18/2016
Last updated
09/04/2023
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