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NPI Code Detail

MEDICARE: BRENDA LYNN DERRY ACIT II, MATS

MEDICARE: BRENDA LYNN DERRY ACIT II, MATS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1225762636
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA LYNN DERRY ACIT II, MATS
Provider Business Mailing Address
First Line : 3640 N BRIARWOOD LN
Second Line :
City : MUNCIE
State : IN
Zip : 47304-6375
Country : US
Telephone Number : 463-777-5621
Fax Number : 765-288-6520
Provider Business Practice Location Address
First Line : 3640 N BRIARWOOD LN
Second Line :
City : MUNCIE
State : IN
Zip : 47304-6375
Country : US
Telephone Number : 463-777-5621
Fax Number : 765-288-6520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2022
Last Update Date : 07/12/2022

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