Healthcare Provider Details

I. General information

NPI: 1134969835
Provider Name (Legal Business Name): ASHTON BRETT TAYLOR MSW, LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GOOD AVE
INDIANAPOLIS IN
46219-7210
US

IV. Provider business mailing address

203 GOOD AVE
INDIANAPOLIS IN
46219-7210
US

V. Phone/Fax

Practice location:
  • Phone: 317-912-0096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34013001A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: