Provider Demographics
NPI:1447262746
Name:BRITTINGHAM, MIMI M (LMFT, LMHC, CNS)
Entity type:Individual
Prefix:MS
First Name:MIMI
Middle Name:M
Last Name:BRITTINGHAM
Suffix:
Gender:F
Credentials:LMFT, LMHC, CNS
Other - Prefix:
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Mailing Address - Street 1:210 E 91ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1569
Mailing Address - Country:US
Mailing Address - Phone:317-844-0055
Mailing Address - Fax:317-571-5040
Practice Address - Street 1:210 E 91ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1569
Practice Address - Country:US
Practice Address - Phone:317-844-0055
Practice Address - Fax:317-571-5040
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN39000787A101YM0800X, 101YP2500X
IN35000985A106H00000X
IN70000166A364S00000X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Not Answered364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent