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General NPI Number Information
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NPI Number | 1407979917
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Entity Type | Organization
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Legal Business Name | JOANN R HISCOX
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 200 FERRY ST SUITE K
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City | LAFAYETTE
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State | IN
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Zip | 47901-1172
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Country | US
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Telephone | 765-428-8108
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Fax | 765-429-7088
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Provider Business Mailing Address
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Address Line | 200 FERRY ST SUITE K
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City | LAFAYETTE
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State | IN
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Zip | 47901-1172
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Country | US
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Telephone | 765-428-8108
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Fax | 765-429-7088
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Authorized Official
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Title or Position | OWNER
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Name | JOANN HISCOX
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Credential | MS, NCC, LMHC
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Telephone | 765-428-8108
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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 | 39000412A
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License Number State | IN
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