Provider Demographics
NPI:1346743952
Name:KAIROS COUNSELING
Entity Type:Organization
Organization Name:KAIROS COUNSELING
Other - Org Name:KAIROS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-457-7215
Mailing Address - Street 1:928 SYCAMORE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-9283
Mailing Address - Country:US
Mailing Address - Phone:812-457-7215
Mailing Address - Fax:
Practice Address - Street 1:928 SYCAMORE ST STE 2
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-9283
Practice Address - Country:US
Practice Address - Phone:812-457-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAIROS COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty