Provider Demographics
NPI:1114780780
Name:WELLFIELD COUNSELING, LLC
Entity Type:Organization
Organization Name:WELLFIELD COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER & THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:317-426-7689
Mailing Address - Street 1:9801 FALL CREEK RD # 105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4802
Mailing Address - Country:US
Mailing Address - Phone:317-426-7689
Mailing Address - Fax:
Practice Address - Street 1:12512 DOE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-6000
Practice Address - Country:US
Practice Address - Phone:317-426-7689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty