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General NPI Number Information
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NPI Number | 1184483109
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Entity Type | Organization
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Legal Business Name | PHOENIX TREE COUNSELING, LLC
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 100 EXECUTIVE DR STE K
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City | LAFAYETTE
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State | IN
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Zip | 47905-4865
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Country | US
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Telephone | 317-938-3141
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Fax |
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Provider Business Mailing Address
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Address Line | 1644 E 450 S
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City | CHALMERS
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State | IN
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Zip | 47929-8011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER/THERAPIST
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Name | TAWNY CULVER
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Credential | LCSW
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Telephone | 317-938-3141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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