Provider Demographics
NPI:1497132179
Name:STRATEGIC COACHING AND THERAPIES LLC
Entity Type:Organization
Organization Name:STRATEGIC COACHING AND THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JUERGENSEN SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-218-3479
Mailing Address - Street 1:8872 CRYSTAL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6434
Mailing Address - Country:US
Mailing Address - Phone:317-218-3479
Mailing Address - Fax:317-816-7001
Practice Address - Street 1:3815 RIVER CROSSING PARKWAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-9998
Practice Address - Country:US
Practice Address - Phone:317-847-2244
Practice Address - Fax:317-816-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN350001957A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1265Medicare PIN