Provider Demographics
NPI:1023368313
Name:INDY COUNSELING PROFESSIONALS
Entity Type:Organization
Organization Name:INDY COUNSELING PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIMKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-496-3704
Mailing Address - Street 1:5660 CAITO DRIVE, STE 122
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1364
Mailing Address - Country:US
Mailing Address - Phone:317-377-3103
Mailing Address - Fax:317-377-3103
Practice Address - Street 1:5660 CAITO DRIVE, STE 122
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1364
Practice Address - Country:US
Practice Address - Phone:317-377-3103
Practice Address - Fax:317-377-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005352A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530Medicaid
IN150074Medicare PIN