Provider Demographics
NPI:1699368795
Name:SYCAMORE FAMILY SERVICES OF INDIANA
Entity Type:Organization
Organization Name:SYCAMORE FAMILY SERVICES OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCAC, LMHC
Authorized Official - Phone:317-371-1122
Mailing Address - Street 1:4119 LONGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268
Mailing Address - Country:US
Mailing Address - Phone:317-937-1122
Mailing Address - Fax:
Practice Address - Street 1:3445 W 71ST STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268
Practice Address - Country:US
Practice Address - Phone:317-937-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty