Healthcare Provider Details

I. General information

NPI: 1649951450
Provider Name (Legal Business Name): BREANNA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MITCHELL RD STE C
BEDFORD IN
47421-4747
US

IV. Provider business mailing address

8003 CASTLEWAY DR
INDIANAPOLIS IN
46250-1946
US

V. Phone/Fax

Practice location:
  • Phone: 812-393-8070
  • Fax: 812-954-5024
Mailing address:
  • Phone: 317-576-1335
  • Fax: 317-343-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012632A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: