Provider Demographics
NPI:1346792702
Name:TERRE HAUTE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TERRE HAUTE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-243-9246
Mailing Address - Street 1:609 E SURGERY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-6815
Mailing Address - Country:US
Mailing Address - Phone:812-243-9246
Mailing Address - Fax:812-917-5071
Practice Address - Street 1:2849 E NORTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805-2621
Practice Address - Country:US
Practice Address - Phone:812-243-9246
Practice Address - Fax:812-917-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002540A261QM0801X
IN87001181A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11490495OtherCAQH
INM400071454OtherMEDICARE