Provider Demographics
NPI:1689787855
Name:DIGBY-BERRY, CEOLA (PHD HSPP)
Entity Type:Individual
Prefix:
First Name:CEOLA
Middle Name:
Last Name:DIGBY-BERRY
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4371
Mailing Address - Country:US
Mailing Address - Phone:765-284-0879
Mailing Address - Fax:765-284-1480
Practice Address - Street 1:3111 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4371
Practice Address - Country:US
Practice Address - Phone:765-284-0879
Practice Address - Fax:765-284-1480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040153A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN163150000OtherMAGELLAN
IN100333710Medicaid
IN000000186182OtherANTHEM BCBS
INS29499Medicare UPIN
IN945500DMedicare ID - Type Unspecified