Provider Demographics
NPI:1649951450
Name:WHITE, BREANNA
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-0270
Mailing Address - Country:US
Mailing Address - Phone:812-723-3944
Mailing Address - Fax:812-723-7989
Practice Address - Street 1:8163 W STATE ROAD 56 STE A
Practice Address - Street 2:
Practice Address - City:WEST BADEN SPRINGS
Practice Address - State:IN
Practice Address - Zip Code:47469-7706
Practice Address - Country:US
Practice Address - Phone:812-723-7125
Practice Address - Fax:812-936-2599
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker