Healthcare Provider Details

I. General information

NPI: 1922827039
Provider Name (Legal Business Name): EXPRESSIVE HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E CARMEL DR
CARMEL IN
46032-2803
US

IV. Provider business mailing address

14847 SENATOR WAY
CARMEL IN
46032-5128
US

V. Phone/Fax

Practice location:
  • Phone: 317-300-5362
  • Fax:
Mailing address:
  • Phone: 317-300-5362
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERYN SHELTON
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC, ATR
Phone: 317-300-5362