Healthcare Provider Details

I. General information

NPI: 1952127946
Provider Name (Legal Business Name): BRIANA ULREY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N. CANTERBURY COURT
BLOOMINGTON IN
47404-4500
US

IV. Provider business mailing address

550 CONGRESSIONAL BLVD. SUITE 220
CARMEL IN
46032-5400
US

V. Phone/Fax

Practice location:
  • Phone: 317-249-2242
  • Fax: 844-289-6798
Mailing address:
  • Phone: 317-249-2242
  • Fax: 844-289-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-137734
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: