Basic Information
| Provider Information | |||||||||
| NPI: | 1457075848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 WHITELAND RD | ||||||||
| Address2: | |||||||||
| City: | WHITELAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461841424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176071028 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 LIBRARY PARK DR STE A-1 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461421562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178819923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2022 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-22-61666 | IN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.