Healthcare Provider Details

I. General information

NPI: 1134938251
Provider Name (Legal Business Name): INTENTIONAL RELATIONSHIP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E GREYHOUND PASS STE 18-108
CARMEL IN
46033-7787
US

IV. Provider business mailing address

1950 E GREYHOUND PASS STE 18-108
CARMEL IN
46033-7787
US

V. Phone/Fax

Practice location:
  • Phone: 224-408-0156
  • Fax:
Mailing address:
  • Phone: 224-408-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAKISHA CARLA BROOKS
Title or Position: FOUNDER/OWNER/CEO
Credential: LMFT
Phone: 224-408-0156