Provider Demographics
NPI:1770065153
Name:IN TIME CREATIVE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:IN TIME CREATIVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, CCMHC
Authorized Official - Phone:812-208-3175
Mailing Address - Street 1:5105 S. US HWY 41
Mailing Address - Street 2:PMB 227
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4790
Mailing Address - Country:US
Mailing Address - Phone:812-382-5512
Mailing Address - Fax:
Practice Address - Street 1:619 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3125
Practice Address - Country:US
Practice Address - Phone:812-382-5512
Practice Address - Fax:812-244-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-03
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390002582A261QM0801X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty