Provider Demographics
NPI:1174679831
Name:PRIMEAU, BRIAN (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PRIMEAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:PREMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2900 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:W LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-3744
Mailing Address - Country:US
Mailing Address - Phone:765-463-2555
Mailing Address - Fax:765-497-3960
Practice Address - Street 1:2900 N RIVER RD
Practice Address - Street 2:
Practice Address - City:W LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3744
Practice Address - Country:US
Practice Address - Phone:765-463-2555
Practice Address - Fax:765-497-3960
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical