Provider Demographics
NPI:1801784798
Name:TOWNSEND, MONIQUE BRENEA
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:BRENEA
Last Name:TOWNSEND
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 1:3388 PEPPERMILL DR APT 1C
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4133
Mailing Address - Country:US
Mailing Address - Phone:765-761-1406
Mailing Address - Fax:
Practice Address - Street 1:10549 W US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:IN
Practice Address - Zip Code:47948-8613
Practice Address - Country:US
Practice Address - Phone:219-863-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBACB1119116103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst