Healthcare Provider Details

I. General information

NPI: 1013505205
Provider Name (Legal Business Name): MARKLE PROFESSIONAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 KENTUCKY AVE
INDIANAPOLIS IN
46221-2700
US

IV. Provider business mailing address

50 E GREYHOUND PASS
CARMEL IN
46032-1039
US

V. Phone/Fax

Practice location:
  • Phone: 317-210-1046
  • Fax:
Mailing address:
  • Phone: 317-210-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SHANA MARKLE
Title or Position: MEMBER
Credential: PH.D.
Phone: 317-210-1046