Provider Demographics
NPI:1982651451
Name:CG CONSULTING AND THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CG CONSULTING AND THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GUM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:317-913-0350
Mailing Address - Street 1:8724 SARGENT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1376
Mailing Address - Country:US
Mailing Address - Phone:317-913-0350
Mailing Address - Fax:317-913-0351
Practice Address - Street 1:8724 SARGENT CREEK LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1376
Practice Address - Country:US
Practice Address - Phone:317-913-0350
Practice Address - Fax:317-913-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001785A225100000X, 2251N0400X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========100OtherCARESOURCE
IN=========001OtherANTHEM