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General NPI Number Information
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NPI Number | 1689028458
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Entity Type | Organization
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Legal Business Name | ALLEN'S THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 5455 W 86TH ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1504
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Country | US
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Telephone | 317-820-3600
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Fax | 317-663-0914
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Provider Business Mailing Address
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Address Line | 5455 W 86TH ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1504
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Country | US
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Telephone | 317-820-3600
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Fax | 317-663-0914
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Authorized Official
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Title or Position | OWNER
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Name | ALLEN MARCELLUS RADER
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Credential | LCSW
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Telephone | 317-446-5676
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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 | 34003862A
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License Number State | IN
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