Provider Demographics
NPI:1083019954
Name:BRANT, AMY RENE (MSE, LSC, LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENE
Last Name:BRANT
Suffix:
Gender:F
Credentials:MSE, LSC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9953 CROSSPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3391
Mailing Address - Country:US
Mailing Address - Phone:317-721-4801
Mailing Address - Fax:317-595-0933
Practice Address - Street 1:9953 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-721-4801
Practice Address - Fax:317-595-0933
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000196A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist