Bracy, Odie L

Bracy, Odie L is an individual health care provider with primary practice located at 6555 Carrollton Ave , Indianapolis IN 46220-1664. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as his primary health care specialty. Bracy, Odie L can be contacted via phone (317) 257-9672.

Contact Information

Primary practice address
6555 Carrollton Ave Indianapolis IN 46220-1664
Phone: (317) 257-9672
Fax: (317) 257-9674
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 20010368A Indiana

Profile Details

NPI number 1285639476
LBN Legal business name Bracy, Odie L
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2005
Last updated Dec 29th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285639476 NPPES
Indiana Other 000000085922 ANTHEM BC/BS
Indiana MEDICAID 100073260 ANTHEM BC/BS

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