=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326199894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY CONSULTING & COUNSELING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 12/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5170 E 65TH ST STE. 107
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46220-4892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-702-4600
-----------------------------------------------------
Fax | 317-252-0274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5170 E 65TH ST STE 107
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46220-4892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-702-4600
-----------------------------------------------------
Fax | 317-252-0274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO AND THERAPIST
-----------------------------------------------------
Name | MS. TINA N JOHNSON-FRY SMITH
-----------------------------------------------------
Credential | MS LMFT LMHC
-----------------------------------------------------
Telephone | 317-492-3871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------