Healthcare Provider Details

I. General information

NPI: 1417743881
Provider Name (Legal Business Name): HMWP PSYCHOLOGY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 3RD AVE SW STE 203
CARMEL IN
46032-7596
US

IV. Provider business mailing address

1089 3RD AVE SW STE 203
CARMEL IN
46032-7596
US

V. Phone/Fax

Practice location:
  • Phone: 617-388-8637
  • Fax: 317-219-0747
Mailing address:
  • Phone: 617-388-8637
  • Fax: 317-209-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LANCE LACONI
Title or Position: MANAGER
Credential:
Phone: 617-388-8627