Basic Information
Provider Information
NPI: 1750510012
EntityType: 2
ReplacementNPI:  
OrganizationName: ASPIRE INDIANA INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BEHAVIORCORP
OtherOrganizationType: 4
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9615 E 148TH ST
Address2: SUITE 1
City: NOBLESVILLE
State: IN
PostalCode: 460604371
CountryCode: US
TelephoneNumber: 3175870500
FaxNumber: 3176740060
Practice Location
Address1: 9615 E 148TH ST
Address2: SUITE 1
City: NOBLESVILLE
State: IN
PostalCode: 460604371
CountryCode: US
TelephoneNumber: 3175870500
FaxNumber: 3176740060
Other Information
ProviderEnumerationDate: 07/08/2009
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CROCKET
AuthorizedOfficialFirstName: TIMOTHY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 3175870517
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X430-0-CMHCINY193400000X SINGLE SPECIALTY GROUPOther Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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