Healthcare Provider Details

I. General information

NPI: 1346784626
Provider Name (Legal Business Name): FAMILY AND COMMUNITY SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 RUCKER RD STE E
INDIANAPOLIS IN
46220-4868
US

IV. Provider business mailing address

6437 RUCKER RD STE E
INDIANAPOLIS IN
46220-4868
US

V. Phone/Fax

Practice location:
  • Phone: 317-679-4181
  • Fax:
Mailing address:
  • Phone: 317-679-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20010499A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001938A
License Number StateIN

VIII. Authorized Official

Name: ELIZABETH EVERETT
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 317-679-4181