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General NPI Number Information
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NPI Number | 1093019812
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Entity Type | Organization
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Legal Business Name | PATHWAY TO EQUANIMITY, LLC
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Dates
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Enumeration Date | 01/08/2011
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Last Update Date | 01/08/2011
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Provider Practice Location Address
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Address Line | 3905 VINCENNES RD TEN FORTUNE PARK, SUITE 303
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3026
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Country | US
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Telephone | 317-471-3522
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Fax | 317-471-3508
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Provider Business Mailing Address
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Address Line | 3905 VINCENNES RD TEN FORTUNE PARK, SUITE 303
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3026
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Country | US
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Telephone | 317-471-3522
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Fax | 317-471-3508
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | UNCHANA THAMASAK
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Credential | LMHC, LCAC
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Telephone | 317-371-2373
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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 | 39000112A
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License Number State | IN
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