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General NPI Number Information
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NPI Number | 1346792702
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Entity Type | Organization
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Legal Business Name | TERRE HAUTE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 2849 E NORTHWOOD AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47805-2621
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Country | US
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Telephone | 812-243-9246
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Fax | 812-917-5091
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Provider Business Mailing 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 | 812-243-9246
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Fax | 812-917-5071
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JANET MCBRIDE
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Credential | LCSW
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Telephone | 812-243-9246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 87001181A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 34002540A
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License Number State | IN
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