MEDICARE: KEITH AARON SIMS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34007768A	IN

General Provider Information

NPI Number	:	1194157636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH AARON SIMS LCSW

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 W MOUND ST
Second Line	:
City	:	NASHVILLE
State	:	IN
Zip	:	47448-7049
Country	:	US
Telephone Number	:	812-988-2258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/30/2022

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