Provider Demographics
NPI:1568628089
Name:DALE, BRITTANY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:ANN
Last Name:DALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 W STATE ROAD 234
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9535
Mailing Address - Country:US
Mailing Address - Phone:317-517-7299
Mailing Address - Fax:
Practice Address - Street 1:526 N MARTIN AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3537
Practice Address - Country:US
Practice Address - Phone:765-287-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042439A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist