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General NPI Number Information
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NPI Number | 1003444985
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Entity Type | Organization
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Legal Business Name | COURAGEOUS HEALING INC
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 2013 S ANTHONY BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46803-3609
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Country | US
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Telephone | 260-417-4801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10156
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City | FORT WAYNE
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State | IN
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Zip | 46850-0156
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Country | US
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Telephone | 260-417-4801
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | JANELL LANE
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Credential | MA
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Telephone | 260-417-4801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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