Healthcare Provider Details

I. General information

NPI: 1649245275
Provider Name (Legal Business Name): ANNIE SEBRING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

850 N MERIDIAN ST
INDIANAPOLIS IN
46204-1098
US

V. Phone/Fax

Practice location:
  • Phone: 317-630-8485
  • Fax: 317-630-7616
Mailing address:
  • Phone: 317-554-2702
  • Fax: 317-554-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001269A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number39001269A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39001269A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000446A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: