Healthcare Provider Details

I. General information

NPI: 1194580456
Provider Name (Legal Business Name): SYDNEY B ISLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17711 DARTOWN RD STE 146
WESTFIELD IN
46074-9208
US

IV. Provider business mailing address

17711 DARTOWN RD STE 146
WESTFIELD IN
46074-9208
US

V. Phone/Fax

Practice location:
  • Phone: 317-660-5532
  • Fax:
Mailing address:
  • Phone: 317-660-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SYDNEY ISLEY
Title or Position: OWNER
Credential:
Phone: 317-660-5532