Healthcare Provider Details

I. General information

NPI: 1841009347
Provider Name (Legal Business Name): MIDWEST COUNSELING CENTER IN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E MAIN ST
WESTFIELD IN
46074-5300
US

IV. Provider business mailing address

15813 72ND AVE FL 2
FRESH MEADOWS NY
11365-4100
US

V. Phone/Fax

Practice location:
  • Phone: 781-558-8696
  • Fax:
Mailing address:
  • Phone: 716-819-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER FOSTER
Title or Position: CEO
Credential:
Phone: 781-558-8696