Healthcare Provider Details

I. General information

NPI: 1770065153
Provider Name (Legal Business Name): IN TIME CREATIVE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 CHERRY ST
TERRE HAUTE IN
47807-3125
US

IV. Provider business mailing address

5105 S. US HWY 41 PMB 227
TERRE HAUTE IN
47802-4790
US

V. Phone/Fax

Practice location:
  • Phone: 812-382-5512
  • Fax: 812-244-2762
Mailing address:
  • Phone: 812-382-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number390002582A
License Number StateIN

VIII. Authorized Official

Name: MRS. THERESA WHITE
Title or Position: CEO
Credential: LMHC, NCC, CCMHC
Phone: 812-208-3175