Provider Demographics
NPI:1821407503
Name:INDIGO COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:INDIGO COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:419-775-1771
Mailing Address - Street 1:1230 LEXINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2679
Mailing Address - Country:US
Mailing Address - Phone:419-775-1771
Mailing Address - Fax:419-775-1088
Practice Address - Street 1:1230 LEXINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2679
Practice Address - Country:US
Practice Address - Phone:419-775-1771
Practice Address - Fax:419-775-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1050101Y00000X
OH4741103T00000X
OH892648103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty