Healthcare Provider Details

I. General information

NPI: 1023664315
Provider Name (Legal Business Name): RECORE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3835 EDISON LAKES PARKWAY SUITE # 200
MISHAWAKA IN
46545-3419
US

IV. Provider business mailing address

3835 EDISON LAKES PARKWAY SUITE # 200
MISHAWAKA IN
46545-3419
US

V. Phone/Fax

Practice location:
  • Phone: 574-210-0303
  • Fax: 574-247-1662
Mailing address:
  • Phone: 574-210-0303
  • Fax: 574-247-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINDA A KOHMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 574-210-0303