Healthcare Provider Details

I. General information

NPI: 1063163301
Provider Name (Legal Business Name): SPERANZA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6283 E LAUGHERY CREEK RD
AURORA IN
47001-9768
US

IV. Provider business mailing address

6283 E LAUGHERY CREEK RD
AURORA IN
47001-9768
US

V. Phone/Fax

Practice location:
  • Phone: 859-363-6213
  • Fax:
Mailing address:
  • Phone: 859-363-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN MONTGOMERY
Title or Position: OWNER
Credential: LPCC
Phone: 812-701-2701