Provider Demographics
NPI:1194846030
Name:COUNSELING AND PSYCHOLOGY RESOURCES
Entity Type:Organization
Organization Name:COUNSELING AND PSYCHOLOGY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:INDENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-324-6397
Mailing Address - Street 1:321 7TH ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5113
Mailing Address - Country:US
Mailing Address - Phone:828-324-6397
Mailing Address - Fax:828-324-2320
Practice Address - Street 1:321 7TH ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5113
Practice Address - Country:US
Practice Address - Phone:828-324-6397
Practice Address - Fax:828-324-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000307Medicaid
NC2816614AMedicare ID - Type Unspecified