Provider Demographics
NPI:1275852048
Name:HARTLEY, BREANNE (BCBA, PHD)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:BCBA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1972
Mailing Address - Country:US
Mailing Address - Phone:317-848-4774
Mailing Address - Fax:317-848-2862
Practice Address - Street 1:9830 BAUER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1972
Practice Address - Country:US
Practice Address - Phone:317-848-4774
Practice Address - Fax:317-848-2862
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IN1-07-3493103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist