Healthcare Provider Details

I. General information

NPI: 1295189652
Provider Name (Legal Business Name): NLT COUNSELING SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 N AVON AVE SUITE 300
AVON IN
46123-9513
US

IV. Provider business mailing address

192 N AVON AVE SUITE 300
AVON IN
46123-9513
US

V. Phone/Fax

Practice location:
  • Phone: 317-672-6400
  • Fax: 317-672-6401
Mailing address:
  • Phone: 317-672-6400
  • Fax: 317-672-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number34005642A
License Number StateIN

VIII. Authorized Official

Name: NAKIA THIGPEN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 317-600-8890