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General NPI Number Information
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NPI Number | 1235369034
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Entity Type | Organization
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Legal Business Name | MAKE IT LAST 4-EVER CLINICAL FAMILY SERVICES
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 120 E MARKET ST STE 460
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-3282
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Country | US
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Telephone | 317-724-4719
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E MARKET ST STE 460
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-3282
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Country | US
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Telephone | 317-724-4719
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Fax |
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR OF OPERATION
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Name | MRS. SHERRI LUANNE KELLEY
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Credential | BA,MA,MS
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Telephone | 317-724-4719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 01033547
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License Number State | IN
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