Healthcare Provider Details

I. General information

NPI: 1164384822
Provider Name (Legal Business Name): OLIVIA JOAN MCGAUGHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2884
US

IV. Provider business mailing address

6308 WHITAKER FARMS DR
INDIANAPOLIS IN
46237-8506
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87900190A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33013323A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: