Healthcare Provider Details

I. General information

NPI: 1467943118
Provider Name (Legal Business Name): BROOKE MORIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12912 COLDWATER RD STE E
FORT WAYNE IN
46845-8871
US

IV. Provider business mailing address

6060 N COLLEGE AVE
INDIANAPOLIS IN
46220-1907
US

V. Phone/Fax

Practice location:
  • Phone: 260-245-1455
  • Fax: 317-815-3861
Mailing address:
  • Phone: 317-584-5166
  • Fax: 317-815-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: