Healthcare Provider Details

I. General information

NPI: 1831973536
Provider Name (Legal Business Name): DESIREE RAUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HARCOURT RD
INDIANAPOLIS IN
46260-2036
US

IV. Provider business mailing address

1440 EVANS AVE
NOBLESVILLE IN
46060-1824
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005806A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: