Provider Demographics
NPI:1295189652
Name:NLT COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:NLT COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-600-8890
Mailing Address - Street 1:192 N AVON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9513
Mailing Address - Country:US
Mailing Address - Phone:317-672-6400
Mailing Address - Fax:317-672-6401
Practice Address - Street 1:192 N AVON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9513
Practice Address - Country:US
Practice Address - Phone:317-672-6400
Practice Address - Fax:317-672-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005642A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health