=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124662226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL CIRCLE FAMILY SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2019
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5141 W HESSLER RD STE D
-----------------------------------------------------
City | MUNCIE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47304-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-231-6922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4326 S SCATTERFIELD RD # 202
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46013-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-606-9609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENIFER MUDD-CHAMBERLAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-231-6922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------