Healthcare Provider Details

I. General information

NPI: 1851626386
Provider Name (Legal Business Name): COLLABORATING FOR KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LIBRARY BLVD STE A
GREENWOOD IN
46142-1567
US

IV. Provider business mailing address

1701 LIBRARY BLVD STE A
GREENWOOD IN
46142-1567
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-9923
  • Fax:
Mailing address:
  • Phone: 317-881-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number22004716A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number22004716A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number22004716A
License Number StateIN
# 8
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM CASSEL
Title or Position: CEO
Credential:
Phone: 317-881-9923