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General NPI Number Information
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NPI Number | 1083906531
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Entity Type | Organization
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Legal Business Name | FAMILY PRESERVATION COUNSELING & CONSULTING
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 5555 N TACOMA AVE SUITE 201
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3512
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Country | US
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Telephone | 317-259-7122
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Fax | 317-259-7167
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Provider Business Mailing Address
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Address Line | 5555 N TACOMA AVE SUITE 201
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3512
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Country | US
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Telephone | 317-259-7122
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Fax | 317-259-7167
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | MRS. DEBRA DENIESE BUCKNER
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Credential | LCSW
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Telephone | 317-259-7122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34002010A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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