Healthcare Provider Details

I. General information

NPI: 1104359009
Provider Name (Legal Business Name): LINKS FOR SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 SARASOTA CT
INDIANAPOLIS IN
46219-2531
US

IV. Provider business mailing address

8525 SARASOTA CT
INDIANAPOLIS IN
46219-2531
US

V. Phone/Fax

Practice location:
  • Phone: 317-603-6658
  • Fax:
Mailing address:
  • Phone: 317-603-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA RENAE WEAVER
Title or Position: OWNER/THERAPIST
Credential: LMHC
Phone: 317-603-6658