Provider Demographics
NPI:1235369034
Name:MAKE IT LAST 4-EVER CLINICAL FAMILY SERVICES
Entity Type:Organization
Organization Name:MAKE IT LAST 4-EVER CLINICAL FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR OF OPERATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LUANNE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA,MA,MS
Authorized Official - Phone:317-724-4719
Mailing Address - Street 1:120 E MARKET ST STE 460
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3282
Mailing Address - Country:US
Mailing Address - Phone:317-724-4719
Mailing Address - Fax:
Practice Address - Street 1:120 E MARKET ST STE 460
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3282
Practice Address - Country:US
Practice Address - Phone:317-724-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty