Healthcare Provider Details

I. General information

NPI: 1083214159
Provider Name (Legal Business Name): AMBER KINNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E 64TH ST STE 240
INDIANAPOLIS IN
46220-1672
US

IV. Provider business mailing address

819 E 64TH ST STE 240
INDIANAPOLIS IN
46220-1672
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMBER KINNEY
Title or Position: OWNER/THERAPIST
Credential: LMHC
Phone: --