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General NPI Number Information
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NPI Number | 1104562859
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Entity Type | Individual
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Provider Name | MARY KATHERINE ESHAM
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Gender | Female
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 2626 E 46TH ST STE J
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2373
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Country | US
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Telephone | 463-213-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2626 E 46TH ST STE J
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2373
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Country | US
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Telephone | 463-213-3937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-208623
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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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