Provider Demographics
NPI:1902474109
Name:SALMOND, BRAE MARVIN (LMHC)
Entity Type:Individual
Prefix:
First Name:BRAE
Middle Name:MARVIN
Last Name:SALMOND
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 E 86TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1842
Mailing Address - Country:US
Mailing Address - Phone:317-245-3552
Mailing Address - Fax:317-516-6652
Practice Address - Street 1:941 E 86TH ST STE 112
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1842
Practice Address - Country:US
Practice Address - Phone:317-792-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004091A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health