Healthcare Provider Details

I. General information

NPI: 1649219049
Provider Name (Legal Business Name): INDIANAPOLIS INSTITUTE FOR FAMILIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 N HIGH SCHOOL RD
INDIANAPOLIS IN
46214-3684
US

IV. Provider business mailing address

618 N HIGH SCHOOL RD
INDIANAPOLIS IN
46214-3684
US

V. Phone/Fax

Practice location:
  • Phone: 317-381-0355
  • Fax: 317-381-0356
Mailing address:
  • Phone: 317-381-0355
  • Fax: 317-381-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIN

VIII. Authorized Official

Name: DIANE A BURKS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 317-381-0355