Van Dyke, Jacob Alexander

Van Dyke, Jacob Alexander is an individual health care provider with primary practice located at 175 Market Place Dr Ste A , Louisville KY 40229-4471. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is his primary health care specialty. Van Dyke, Jacob Alexander can be contacted via phone (502) 251-7002.

Contact Information

Primary practice address
175 Market Place Dr Ste A Louisville KY 40229-4471
Phone: (502) 251-7002
Fax: (317) 520-8200
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X RBT-19-102036
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 278031 Kentucky

Profile Details

NPI number 1477191401
LBN Legal business name Van Dyke, Jacob Alexander
Credentials MA, BCBA, LBA
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 20th, 2019
Last updated Jun 8th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1477191401 NPPES
Other RBT-19-102036 RBT CERTIFICATE
Other 1-22-595-49 RBT CERTIFICATE

Popular Providers