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General NPI Number Information
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NPI Number | 1598332793
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON COUNSELING CENTER
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 463 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5005
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Country | US
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Telephone | 812-369-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 463 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5005
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Country | US
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Telephone | 812-369-4333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN LYNNE OAKLEY
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Credential | LMHC
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Telephone | 812-599-4066
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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 |
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License Number State |
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