Healthcare Provider Details

I. General information

NPI: 1699240507
Provider Name (Legal Business Name): COMPLETE TUTORING & MENTORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 CEDAR PLACE DR STE 112
INDIANAPOLIS IN
46240-2344
US

IV. Provider business mailing address

9135 N MERIDIAN ST STE B8
INDIANAPOLIS IN
46260-1816
US

V. Phone/Fax

Practice location:
  • Phone: 317-750-5189
  • Fax:
Mailing address:
  • Phone: 317-750-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: SHENAY GOLDEN
Title or Position: PRESIDENT
Credential:
Phone: 317-750-5189