NPIMap

Organization Active NPI

Marshall Devolopmental Therapy Services Inc

  • Behavior Analyst
  • Walnut Grove, MS
National Provider Identifier
1376188086
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
MARSHALL DEVOLOPMENTAL THERAPY SERVICES INC
Practice address
308 Estes Mill Rd
Walnut Grove, MS 39189-5043
Phone
(317) 388-8131
NPI assigned
Nov 18, 2019
Last updated
Dec 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Angelica N Gray, BCBANPI 1316225014
Title
Principle
Phone
(317) 388-8131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X NU Primary

Addresses

Primary practice location

308 Estes Mill Rd
Walnut Grove, MS 39189-5043

Mailing address

8650 Commerce Park PL Ste A1
Indianapolis, IN 46268-3174
Phone (317) 388-8131

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address angelica@tiiba.org Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1376188086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8650 COMMERCE PARK PL STE A1",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462683174",
            "telephone_number": "317-388-8131",
            "fax_number": "317-536-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 ESTES MILL RD",
            "city": "WALNUT GROVE",
            "state": "MS",
            "postal_code": "391895043",
            "telephone_number": "317-388-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL DEVOLOPMENTAL THERAPY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-18",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "ANGELICA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRINCIPLE",
        "authorized_official_telephone_number": "317-388-8131",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "angelica@tiiba.org",
            "affiliation": "N",
            "endpointDescription": "BCBA Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "308 Estes Mill Rd",
            "city": "Walnut Grove",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391895043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Walnut Grove, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.