Provider Demographics
NPI:1851987051
Name:PROFOUND PURPOSE COUNSELING LLC
Entity Type:Organization
Organization Name:PROFOUND PURPOSE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WONDER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-525-2861
Mailing Address - Street 1:5496 TRACEY JO CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9690
Mailing Address - Country:US
Mailing Address - Phone:317-525-2861
Mailing Address - Fax:
Practice Address - Street 1:1701 LIBRARY BLVD STE E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1567
Practice Address - Country:US
Practice Address - Phone:317-525-2861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-12
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty