MEDICARE: MIDWEST COUNSELING ASSOCIATES

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	251S00000X	Community/Behavioral Health Agency	34002423A	IN

General Provider Information

NPI Number	:	1528327673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	5321 CHEVIOT PLACE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-3239
Country	:	US
Telephone Number	:	317-545-8490
Fax Number	:	317-545-6470

Provider Business Practice Location Address
First Line	:	5321 CHEVIOT PL
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-3239
Country	:	US
Telephone Number	:	317-545-8490
Fax Number	:	317-545-6470

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. HARRY BRUTUS ANDERSON JR.
Credential	:	LCSW
Telephone Number	:	317-545-8490

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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