Healthcare Provider Details

I. General information

NPI: 1255943460
Provider Name (Legal Business Name): SCHOLARS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W 39TH ST APT 2014
INDIANAPOLIS IN
46228-3154
US

IV. Provider business mailing address

3033 W 39TH ST APT 2014
INDIANAPOLIS IN
46228-3154
US

V. Phone/Fax

Practice location:
  • Phone: 317-640-1139
  • Fax:
Mailing address:
  • Phone: 317-640-1139
  • 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 Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY DEWAYNE MARSHALL
Title or Position: CEO
Credential: MBA
Phone: 317-640-1139