MEDICARE: WHITEWATER COUNSELING, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1578105532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITEWATER COUNSELING, LLC

Provider Business Mailing Address
First Line	:	13075 STATE ROAD 1
Second Line	:
City	:	BROOKVILLE
State	:	IN
Zip	:	47012-8702
Country	:	US
Telephone Number	:	765-575-4232
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	IN
Zip	:	47012-1406
Country	:	US
Telephone Number	:	765-575-4232
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN STRIEGLER
Credential	:	LMHC
Telephone Number	:	765-575-4232

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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