Provider Demographics
NPI:1841785458
Name:KOSHNICK, CAITLYN M (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:M
Last Name:KOSHNICK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 SAKSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1208
Mailing Address - Country:US
Mailing Address - Phone:574-543-1149
Mailing Address - Fax:
Practice Address - Street 1:1980 E 116TH ST STE 220
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3516
Practice Address - Country:US
Practice Address - Phone:317-730-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000542A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health