Provider Demographics
NPI:1295938116
Name:COUNSELING OF INDIANA INC.
Entity type:Organization
Organization Name:COUNSELING OF INDIANA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-955-2641
Mailing Address - Street 1:3607 W 16TH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-2558
Mailing Address - Country:US
Mailing Address - Phone:317-955-2641
Mailing Address - Fax:317-955-2687
Practice Address - Street 1:3607 W 16TH ST
Practice Address - Street 2:SUITE2B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-2558
Practice Address - Country:US
Practice Address - Phone:317-955-2641
Practice Address - Fax:317-955-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center