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NPI Code Detail

MEDICARE: BIOFEEDBACK COUNSELING CENTER

MEDICARE: BIOFEEDBACK COUNSELING CENTER
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)34001748AIN

General Provider Information

NPI Number : 1528335924
Entity Type Code : Organization
Provider Name (Legal Business Name) : BIOFEEDBACK COUNSELING CENTER
Provider Business Mailing Address
First Line : 9451 VOYLES RD
Second Line :
City : PEKIN
State : IN
Zip : 47165-9606
Country : US
Telephone Number : 502-641-5989
Fax Number :
Provider Business Practice Location Address
First Line : 2580 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2555
Country : US
Telephone Number : 502-641-5989
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MS. KRYSTAL S ANGEVINE
Credential : LCSW, LCAC
Telephone Number : 502-641-5989
Provider Enumeration Date : 11/29/2011
Last Update Date : 11/29/2011

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Directions to “BIOFEEDBACK COUNSELING CENTER ” Practice Location

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