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General NPI Number Information
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NPI Number | 1205173952
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Entity Type | Organization
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Legal Business Name | LIVING WELL IN COMPANY
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 6284 RUCKER RD SUITE N
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-4865
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Country | US
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Telephone | 317-475-1389
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Fax | 317-475-9089
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Provider Business Mailing Address
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Address Line | 6284 RUCKER RD SUITE N
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-4865
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Country | US
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Telephone | 317-475-1389
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Fax | 317-475-9089
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL NELSON GEORGE
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Credential | M.S., L.C.S.W.
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Telephone | 317-475-1389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05000996A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34002279A
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License Number State | IN
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