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General NPI Number Information
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NPI Number | 1174124648
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Entity Type | Organization
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Legal Business Name | SEDONIA COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 10812 CARDINAL CIR
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City | PLYMOUTH
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State | IN
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Zip | 46563-7968
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Country | US
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Telephone | 317-449-9418
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Fax | 574-800-4114
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Provider Business Mailing Address
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Address Line | 10812 CARDINAL CIR
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City | PLYMOUTH
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State | IN
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Zip | 46563-7968
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Country | US
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Telephone | 317-449-9418
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Fax | 574-800-4114
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA MARIE COOPER
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Credential | LCSW
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Telephone | 317-449-9418
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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