=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013353051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNSELING ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2013
-----------------------------------------------------
Last Update Date | 05/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 931 E 86TH ST STE. 101
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-466-1516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 931 E 86TH ST STE. 101
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-466-1516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR / OWNER
-----------------------------------------------------
Name | CYNTHIA MARIE RAGSDALE
-----------------------------------------------------
Credential | L.M.H.C.
-----------------------------------------------------
Telephone | 317-466-1516
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 39001532A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------