Healthcare Provider Details

I. General information

NPI: 1558142463
Provider Name (Legal Business Name): CHELSEA NEWCOMB THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST STE E
CARMEL IN
46032-1782
US

IV. Provider business mailing address

18282 LAKE WINDS DR
WESTFIELD IN
46074-6324
US

V. Phone/Fax

Practice location:
  • Phone: 317-548-6953
  • Fax:
Mailing address:
  • Phone: 317-698-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: CHELSEA NEWCOMB
Title or Position: OWNER
Credential: LCSW
Phone: 317-698-4744