Healthcare Provider Details

I. General information

NPI: 1194380709
Provider Name (Legal Business Name): ASHLEY WHITE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 EAGLES WATCH LN
INDIANAPOLIS IN
46254-9530
US

IV. Provider business mailing address

4824 EAGLES WATCH LN
INDIANAPOLIS IN
46254-9530
US

V. Phone/Fax

Practice location:
  • Phone: 317-833-2546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005219A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: