Provider Demographics
NPI:1578949756
Name:VOTAW, BRYAN
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:VOTAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7378 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8656
Mailing Address - Country:US
Mailing Address - Phone:317-268-8070
Mailing Address - Fax:
Practice Address - Street 1:7378 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8656
Practice Address - Country:US
Practice Address - Phone:317-268-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health