Provider Demographics
NPI:1558041665
Name:CONAWAY, BRIAN NEIL I (MS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:NEIL
Last Name:CONAWAY
Suffix:I
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10196 HATHERLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8490
Mailing Address - Country:US
Mailing Address - Phone:317-371-8735
Mailing Address - Fax:317-537-2636
Practice Address - Street 1:10196 HATHERLEY WAY
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8490
Practice Address - Country:US
Practice Address - Phone:317-371-8735
Practice Address - Fax:317-537-2636
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000391A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health