Healthcare Provider Details

I. General information

NPI: 1821548777
Provider Name (Legal Business Name): AMERICAN BEHAVIORAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N POST RD STE A
INDIANAPOLIS IN
46219-4213
US

IV. Provider business mailing address

1515 N POST RD STE A
INDIANAPOLIS IN
46219-4213
US

V. Phone/Fax

Practice location:
  • Phone: 317-282-3088
  • Fax: 317-295-2555
Mailing address:
  • Phone: 317-282-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000971A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002287A
License Number StateIN

VIII. Authorized Official

Name: MARY JAMIA JACOBSEN
Title or Position: PRESIDENT
Credential: PHD, PSY,D
Phone: 317-282-3088