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General NPI Number Information
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NPI Number | 1225695745
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Entity Type | Organization
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Legal Business Name | WABASH VALLEY THERAPY, LLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 609 E SURGERY CENTER DR
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City | TERRE HAUTE
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State | IN
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Zip | 47802-6815
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Country | US
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Telephone | 812-917-5091
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Fax |
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Provider Business Mailing Address
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Address Line | 30 ALLENDALE
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4751
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Country | US
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Telephone | 812-230-1699
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | DIANNA COOPER-BOLINSKEY
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Credential | LCSW
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Telephone | 812-230-1699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 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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