Provider Demographics
NPI:1992360416
Name:ISLEY, SYDNEY BETH
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:BETH
Last Name:ISLEY
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 1:12770 W NEW MARKET ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7453
Mailing Address - Country:US
Mailing Address - Phone:317-660-5532
Mailing Address - Fax:
Practice Address - Street 1:12770 W NEW MARKET ST STE 206
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7443
Practice Address - Country:US
Practice Address - Phone:909-907-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002254A106H00000X
CA88861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35002254AOtherLICENSED MARRIAGE AND FAMILY THERAPIST
CA88861OtherLICENSED MARRIAGE AND FAMILY THERAPIST