Provider Demographics
NPI:1205409414
Name:INDIANA COUNSELING AND RESILIENCE CENTER, LLC
Entity type:Organization
Organization Name:INDIANA COUNSELING AND RESILIENCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSNAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-801-3737
Mailing Address - Street 1:2345 S LYNHURST DR
Mailing Address - Street 2:STE 108
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-5100
Mailing Address - Country:US
Mailing Address - Phone:317-801-3737
Mailing Address - Fax:317-756-9906
Practice Address - Street 1:2345 S LYNHURST DR
Practice Address - Street 2:STE 108
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5100
Practice Address - Country:US
Practice Address - Phone:317-801-3737
Practice Address - Fax:317-756-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty