Healthcare Provider Details

I. General information

NPI: 1205402682
Provider Name (Legal Business Name): KRISTA LIN CAUGHEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 S MERIDIAN ST STE 4A
INDIANAPOLIS IN
46217-4960
US

IV. Provider business mailing address

8130 S MERIDIAN ST STE 4A
INDIANAPOLIS IN
46217-4960
US

V. Phone/Fax

Practice location:
  • Phone: 317-889-0635
  • Fax:
Mailing address:
  • Phone: 317-889-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: