Provider Demographics
NPI:1841805769
Name:MALONE, BRENNA SHAE (BS)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:SHAE
Last Name:MALONE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 EASTPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4185
Mailing Address - Country:US
Mailing Address - Phone:502-795-0773
Mailing Address - Fax:800-990-2526
Practice Address - Street 1:2916 PEACH BLOSSOM DR STE 104
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8380
Practice Address - Country:US
Practice Address - Phone:812-202-6144
Practice Address - Fax:800-990-2526
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-20-131148106S00000X
IN1-23-68268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician