Healthcare Provider Details

I. General information

NPI: 1659644771
Provider Name (Legal Business Name): REBECCA SUE HUTTSELL MASTER OF ARTS-COUNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NORTH MERIDIAN STREET SUITE 402
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

124 HAWTHORNE LN
GREENWOOD IN
46142-9430
US

V. Phone/Fax

Practice location:
  • Phone: 317-847-8762
  • Fax: 317-926-9165
Mailing address:
  • Phone: 317-332-9861
  • Fax: 317-893-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000031A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33002855A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39000275A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: