Healthcare Provider Details

I. General information

NPI: 1841838455
Provider Name (Legal Business Name): PATH OF PREVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 RIVER CROSSING PKWY STE 100
INDIANAPOLIS IN
46240-7766
US

IV. Provider business mailing address

3815 RIVER CROSSING PKWY STE 100
INDIANAPOLIS IN
46240-7766
US

V. Phone/Fax

Practice location:
  • Phone: 317-993-6677
  • Fax: 317-344-8291
Mailing address:
  • Phone: 317-993-6677
  • Fax: 317-344-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JODI BATTLE
Title or Position: PRESIDENT/THERAPIST
Credential: LMHC
Phone: 317-993-6677