=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184639015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPPORTUNITIES FOR POSITIVE GROWTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15268 HERRIMAN BLVD
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46060-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-776-8850
-----------------------------------------------------
Fax | 317-776-7039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15268 HERRIMAN BLVD
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46060-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-776-8850
-----------------------------------------------------
Fax | 317-776-7039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DAN KAHL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-776-8850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------