Provider Demographics
NPI:1366035826
Name:KINDRED TIES THERAPY, LLC
Entity Type:Organization
Organization Name:KINDRED TIES THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:812-350-7606
Mailing Address - Street 1:450 JACKSON ST UNIT 1382
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6783
Mailing Address - Country:US
Mailing Address - Phone:812-350-7606
Mailing Address - Fax:
Practice Address - Street 1:3457 LIMESTONE LN APT 1733
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8195
Practice Address - Country:US
Practice Address - Phone:812-350-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty