Provider Demographics
NPI:1053125567
Name:DIVERSE DIMENSIONS BEHAVIOR CONSULTING LLC
Entity type:Organization
Organization Name:DIVERSE DIMENSIONS BEHAVIOR CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEON
Authorized Official - Middle Name:DECANNON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-654-6806
Mailing Address - Street 1:1105 BEAL CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-5360
Mailing Address - Country:US
Mailing Address - Phone:317-654-6806
Mailing Address - Fax:
Practice Address - Street 1:1105 BEAL CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-5360
Practice Address - Country:US
Practice Address - Phone:317-654-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty