Individual
BRET DAVIS EARTHEART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
4307 S LEONARD SPRINGS RD, BLOOMINGTON, IN 47403-4078
(812) 345-2176
(206) 984-2440
Mailing address
4307 S LEONARD SPRINGS RD, BLOOMINGTON, IN 47403-4078
(812) 345-2176
(206) 984-2440
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34006996A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000991115
ANTHEM
IN
01
—
5338998
AETNA
—
Enumeration date
02/07/2011
Last updated
11/29/2018
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