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General NPI Number Information
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NPI Number | 1205409414
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Entity Type | Organization
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Legal Business Name | INDIANA COUNSELING AND RESILIENCE CENTER, LLC
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Dates
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Enumeration Date | 07/24/2021
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 2345 S LYNHURST DR STE 108
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-5100
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Country | US
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Telephone | 317-801-3737
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Fax | 317-756-9906
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Provider Business Mailing Address
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Address Line | 2345 S LYNHURST DR STE 108
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-5100
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Country | US
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Telephone | 317-801-3737
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Fax | 317-756-9906
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER FOSNAUGH
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Credential | LMHC
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Telephone | 317-801-3737
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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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