Provider Demographics
NPI:1265639686
Name:MOCKABEE, TAUSHA (MS, CEO, OWNER)
Entity Type:Individual
Prefix:
First Name:TAUSHA
Middle Name:
Last Name:MOCKABEE
Suffix:
Gender:F
Credentials:MS, CEO, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 N BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-3805
Mailing Address - Country:US
Mailing Address - Phone:317-224-4171
Mailing Address - Fax:
Practice Address - Street 1:549 N BELMONT AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-3805
Practice Address - Country:US
Practice Address - Phone:317-224-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor