Provider Demographics
NPI:1720556640
Name:HUMBLE, BRITTANY LYNN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNN
Last Name:HUMBLE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8637
Mailing Address - Country:US
Mailing Address - Phone:219-242-7995
Mailing Address - Fax:219-242-8631
Practice Address - Street 1:908 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4375
Practice Address - Country:US
Practice Address - Phone:219-242-8592
Practice Address - Fax:219-242-8631
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-20-40596103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1235216672Medicaid