Provider Demographics
NPI:1265960421
Name:SEBASTIAN, BRIANA RAYE (MED, BCBA, COBA, LBA)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:RAYE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MED, BCBA, COBA, LBA
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:RAYE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:6085 EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3269
Practice Address - Country:US
Practice Address - Phone:614-482-4300
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-20864103K00000X
KY248574103K00000X
OHCOBA.318103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-20864OtherBCBA CERTIFICATE