Provider Demographics
NPI:1114253218
Name:FRESH START COUNSELING
Entity Type:Organization
Organization Name:FRESH START COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VEROINCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MAC
Authorized Official - Phone:219-548-9400
Mailing Address - Street 1:1552 W LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-0300
Mailing Address - Country:US
Mailing Address - Phone:219-548-9400
Mailing Address - Fax:219-548-9444
Practice Address - Street 1:1552 W LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-0300
Practice Address - Country:US
Practice Address - Phone:219-548-9400
Practice Address - Fax:219-548-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1194-0-ASO101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty