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General NPI Number Information
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NPI Number | 1669249405
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Entity Type | Organization
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Legal Business Name | 91 PLACE INC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 1125 BROOKSIDE AVE STE 50
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3587
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Country | US
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Telephone | 317-220-8166
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 E 10TH ST STE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-2471
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Country | US
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Telephone | 317-220-8166
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Fax |
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Authorized Official
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Title or Position | THERAPY CENTER DIRECTOR
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Name | CHARLOTTE COX
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Credential | MSW
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Telephone | 740-885-0062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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