Provider Demographics
NPI:1477670586
Name:MAIN STREET COUNSELING CENTER
Entity Type:Organization
Organization Name:MAIN STREET COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:219-661-0888
Mailing Address - Street 1:405 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3252
Mailing Address - Country:US
Mailing Address - Phone:219-663-0888
Mailing Address - Fax:
Practice Address - Street 1:405 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3252
Practice Address - Country:US
Practice Address - Phone:219-663-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000721A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty