Provider Demographics
NPI:1376127530
Name:SMOTHERS, BRIANNA (BCBA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3898 NEW VISION DR STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1719
Practice Address - Country:US
Practice Address - Phone:260-425-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst