Healthcare Provider Details

I. General information

NPI: 1285685149
Provider Name (Legal Business Name): CARL HEDELIUS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

IV. Provider business mailing address

732 N BOLTON AVE
INDIANAPOLIS IN
46219-5902
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-3330
  • Fax: 317-272-0807
Mailing address:
  • Phone: 317-359-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002910A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000354A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000921A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: