Individual
BRANDON WATERBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
498 NW 18TH ST BLDG 416, RICHMOND, IN 47374-2851
(765) 914-3937
Mailing address
7471 GEIST VALLEY BLVD, INDIANAPOLIS, IN 46236-8596
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002851A
IN
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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