Provider Demographics
NPI:1336929983
Name:IBIS COUNSELING AND CONSULTING PC
Entity Type:Organization
Organization Name:IBIS COUNSELING AND CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:317-674-3277
Mailing Address - Street 1:8243 S RISING SUN DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-7526
Mailing Address - Country:US
Mailing Address - Phone:317-674-3277
Mailing Address - Fax:
Practice Address - Street 1:10475 CROSSPOINT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3387
Practice Address - Country:US
Practice Address - Phone:317-674-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty