Healthcare Provider Details

I. General information

NPI: 1508302829
Provider Name (Legal Business Name): CATHERINE CRANDALL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4658 E. STATE RD. 45
BLOOMINGTON IN
47408-9644
US

IV. Provider business mailing address

920 S MANOR RD
BLOOMINGTON IN
47401-5068
US

V. Phone/Fax

Practice location:
  • Phone: 812-797-5218
  • Fax:
Mailing address:
  • Phone: 812-727-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE CRANDALL
Title or Position: TIN OWNER
Credential: LCSW
Phone: 812-727-5218