Individual
DEVANTE LB BARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1217 OLD VINES TRL, GREENWOOD, IN 46143-3412
(317) 533-3507
Mailing address
1217 OLD VINES TRL, GREENWOOD, IN 46143-3412
(317) 533-3507
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/16/2024
Last updated
05/14/2025
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