Provider Demographics
NPI:1922199165
Name:FAMILY COUNSELING CLINIC
Entity Type:Organization
Organization Name:FAMILY COUNSELING CLINIC
Other - Org Name:FAMILY COUSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELUE-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-272-2190
Mailing Address - Street 1:7125 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7968
Mailing Address - Country:US
Mailing Address - Phone:317-272-2190
Mailing Address - Fax:317-272-2199
Practice Address - Street 1:7125 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7968
Practice Address - Country:US
Practice Address - Phone:317-272-2190
Practice Address - Fax:317-272-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100134140AMedicaid
IN343540AMedicare ID - Type Unspecified
IN100134140AMedicaid
IN182920Medicare PIN