Provider Demographics
NPI:1396341822
Name:WHITE, WHITNEY BREANNE (BCBA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BREANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:BREANNE
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:7526 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1461
Mailing Address - Country:US
Mailing Address - Phone:317-222-1886
Mailing Address - Fax:
Practice Address - Street 1:7526 E 82ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1461
Practice Address - Country:US
Practice Address - Phone:317-222-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst