Healthcare Provider Details

I. General information

NPI: 1740874007
Provider Name (Legal Business Name): CENTER FOR COUNSELING, COACHING & CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 3RD ST
COLUMBUS IN
47201-6813
US

IV. Provider business mailing address

724 3RD ST
COLUMBUS IN
47201-6813
US

V. Phone/Fax

Practice location:
  • Phone: 812-447-2464
  • Fax: 800-447-9171
Mailing address:
  • Phone: 812-447-2464
  • Fax: 800-447-9171

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LORI ANN ELLEGOOD
Title or Position: PRESIDENT
Credential: MSW, LCSW
Phone: 812-447-2464