Provider Demographics
NPI:1821627191
Name:FREE TO FLOURISH COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:FREE TO FLOURISH COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:765-808-9642
Mailing Address - Street 1:4319 W CLARA LN
Mailing Address - Street 2:PMB# 305
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5470
Mailing Address - Country:US
Mailing Address - Phone:765-227-3733
Mailing Address - Fax:
Practice Address - Street 1:4304 W COYOTE RUN COURT
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-227-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty