Provider Demographics
NPI:1275075475
Name:ORIGINS FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:ORIGINS FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:317-649-4311
Mailing Address - Street 1:18 E MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-5541
Mailing Address - Country:US
Mailing Address - Phone:176-493-4311
Mailing Address - Fax:317-649-4375
Practice Address - Street 1:18 E MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-5541
Practice Address - Country:US
Practice Address - Phone:176-493-4311
Practice Address - Fax:317-649-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-06
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001907A251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300044207Medicaid