Origins Developmental LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

ORIGINS DEVELOPMENTAL LLC

Practice address

4118 N Clinton St
Fort Wayne, IN 46805-1210

Phone

(260) 483-4988

NPI assigned

May 4, 2017

Organization subpart

No

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

Authorized official

Name

Jason Shaw, MA, BCBA

Title

Chief Operating Officer

Phone

(260) 483-4988

Specialties & licenses 1

Addresses

Other names 1

• ORIGINS DEVELOPMENTAL Other name

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

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1952837346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 TOUBY PIKE STE B",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469012573",
            "telephone_number": "765-628-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4118 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051210",
            "telephone_number": "260-483-4988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGINS DEVELOPMENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-04",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "260-483-4988",
        "authorized_official_credential": "MA, BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORIGINS DEVELOPMENTAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Behavior Analyst in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Behavior Analyst in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.