Provider Demographics
NPI:1255705406
Name:COUNSELWORX
Entity type:Organization
Organization Name:COUNSELWORX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:317-946-3495
Mailing Address - Street 1:1650 GRASSLAND DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7893
Mailing Address - Country:US
Mailing Address - Phone:317-946-3495
Mailing Address - Fax:
Practice Address - Street 1:1650 GRASSLAND DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7893
Practice Address - Country:US
Practice Address - Phone:317-946-3495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIKEL KELLY & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002195A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health