Provider Demographics
NPI:1114237559
Name:SCULLEY, CHARLEEN K
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:K
Last Name:SCULLEY
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 1:17840 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5409
Mailing Address - Country:US
Mailing Address - Phone:317-574-1254
Mailing Address - Fax:317-574-1230
Practice Address - Street 1:2506 WILLOWBROOK PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1542
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-574-1230
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker