Provider Demographics
NPI:1235516667
Name:HART, BRIAN (LMHC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 W. ROYALE DR.
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2264
Mailing Address - Country:US
Mailing Address - Phone:765-284-0043
Mailing Address - Fax:765-284-4112
Practice Address - Street 1:1904 W. ROYALE DR.
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2264
Practice Address - Country:US
Practice Address - Phone:765-284-0043
Practice Address - Fax:765-284-4112
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002678A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health