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General NPI Number Information
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NPI Number | 1538645197
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Entity Type | Organization
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Legal Business Name | STAND LOOK ASK WALK LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 10405 FOX RUN CT
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City | FISHERS
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State | IN
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Zip | 46037-9257
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Country | US
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Telephone | 317-529-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 10405 FOX RUN CT
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City | FISHERS
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State | IN
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Zip | 46037-9257
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Country | US
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Telephone | 317-529-4387
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. JANE ELIZABETH GOODER
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Credential | M ED RD
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Telephone | 317-528-4387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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