Healthcare Provider Details

I. General information

NPI: 1487597910
Provider Name (Legal Business Name): BRENNAN SCOUT THIENEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15627 CLUB ESTATES LN
CARMEL IN
46033-8117
US

IV. Provider business mailing address

15627 CLUB ESTATES LN
CARMEL IN
46033-8117
US

V. Phone/Fax

Practice location:
  • Phone: 317-512-9047
  • Fax:
Mailing address:
  • Phone: 317-512-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberQ477526450
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: