Healthcare Provider Details

I. General information

NPI: 1477956613
Provider Name (Legal Business Name): TIMOTHY OTSU LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 E 38TH ST
INDIANAPOLIS IN
46226-5614
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-6002
  • Fax: 317-880-0417
Mailing address:
  • Phone: 317-880-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007069A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: