=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073858411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON STANTON HELLEMS LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2012
-----------------------------------------------------
Last Update Date | 12/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 STATE ST SUITE NUMBER 18
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47150-4929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-944-2532
-----------------------------------------------------
Fax | 812-944-2549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2229 FAWCETT HILL RD
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47150-5054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-537-4270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34006617A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3705
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------