Healthcare Provider Details

I. General information

NPI: 1205409414
Provider Name (Legal Business Name): INDIANA COUNSELING AND RESILIENCE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 S LYNHURST DR STE 108
INDIANAPOLIS IN
46241-5100
US

IV. Provider business mailing address

2345 S LYNHURST DR STE 108
INDIANAPOLIS IN
46241-5100
US

V. Phone/Fax

Practice location:
  • Phone: 317-801-3737
  • Fax: 317-756-9906
Mailing address:
  • Phone: 317-801-3737
  • Fax: 317-756-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER FOSNAUGH
Title or Position: OWNER
Credential: LMHC
Phone: 317-801-3737