Healthcare Provider Details

I. General information

NPI: 1215669387
Provider Name (Legal Business Name): KALA D ANDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 HART ST
DYER IN
46311-1736
US

IV. Provider business mailing address

123 BEIRIGER DR
DYER IN
46311-2178
US

V. Phone/Fax

Practice location:
  • Phone: 331-442-7815
  • Fax:
Mailing address:
  • Phone: 331-442-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KALA D ANDERS
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LCPC
Phone: 331-442-7815