Provider Demographics
NPI:1629553516
Name:ERVIN, BRETTANY
Entity Type:Individual
Prefix:
First Name:BRETTANY
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N PENNSYLVANIA ST UNIT 401
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2418
Mailing Address - Country:US
Mailing Address - Phone:317-828-0487
Mailing Address - Fax:
Practice Address - Street 1:115 N PENNSYLVANIA ST UNIT 401
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2418
Practice Address - Country:US
Practice Address - Phone:317-828-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor