Organization
ORIGINS DEVELOPMENTAL LLC
Active
Other names
ORIGINS DEVELOPMENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
JASON SHAW MA, BCBA (CHIEF OPERATING OFFICER)
(260) 483-4988
Entity
Organization
Contact information
Practice address
4118 N CLINTON ST, FORT WAYNE, IN 46805-1210
(260) 483-4988
Mailing address
1824 TOUBY PIKE STE B, KOKOMO, IN 46901-2573
(765) 628-7400
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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