Healthcare Provider Details

I. General information

NPI: 1083430557
Provider Name (Legal Business Name): NAMI WEST CENTRAL INDIANA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N. 18TH STREET SUITE 104
LAFAYETTE IN
47904
US

IV. Provider business mailing address

615 N. 18TH STREET SUITE 104
LAFAYETTE IN
47904
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-6939
  • Fax:
Mailing address:
  • Phone: 765-423-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERI MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-426-2029