Healthcare Provider Details

I. General information

NPI: 1154653426
Provider Name (Legal Business Name): FAMILY PIECE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 S 00 EW
KOKOMO IN
46902-5205
US

IV. Provider business mailing address

331 N INDIANA ST
GREENTOWN IN
46936-1240
US

V. Phone/Fax

Practice location:
  • Phone: 765-461-2900
  • Fax:
Mailing address:
  • Phone: 765-461-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001962A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001758A
License Number StateIN

VIII. Authorized Official

Name: MR. STEVE S DUTTON
Title or Position: OWNER & COO
Credential: LMHC
Phone: 765-507-0325