Provider Demographics
NPI:1255729950
Name:SELF-CONCEPTS GLOBAL SERVICES
Entity type:Organization
Organization Name:SELF-CONCEPTS GLOBAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AKOSUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKEMAN GYEABOA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC, CCTP
Authorized Official - Phone:317-672-3688
Mailing Address - Street 1:1640 KESSLER BOULEVARD WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1955
Mailing Address - Country:US
Mailing Address - Phone:317-672-3688
Mailing Address - Fax:317-672-3688
Practice Address - Street 1:1640 KESSLER BOULEVARD WEST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1955
Practice Address - Country:US
Practice Address - Phone:317-672-3688
Practice Address - Fax:317-672-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001017A101YA0400X, 101YM0800X, 101YP1600X, 103K00000X, 106H00000X
IN34000416A1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty