Provider Demographics
NPI:1508491648
Name:BRANDLE, KRISTA (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BRANDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9660 E WASHINGTON ST STE 300
Mailing Address - Street 2:SUITE 180
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3032
Mailing Address - Country:US
Mailing Address - Phone:317-860-5600
Mailing Address - Fax:
Practice Address - Street 1:9660 E WASHINGTON ST STE 300
Practice Address - Street 2:SUITE 180
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3032
Practice Address - Country:US
Practice Address - Phone:317-860-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2025-09-24
Deactivation Date:2023-03-27
Deactivation Code:
Reactivation Date:2023-04-06
Provider Licenses
StateLicense IDTaxonomies
IN3401029A1041C0700X
IN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst