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General NPI Number Information
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NPI Number | 1689230195
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Entity Type | Organization
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Legal Business Name | BEST LIFE THERAPY, LLC
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Dates
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Enumeration Date | 05/10/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 5555 N TACOMA AVE STE 104
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3551
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Country | US
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Telephone | 317-824-9361
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Fax | 317-219-0827
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Provider Business Mailing Address
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Address Line | 5555 N TACOMA AVE STE 104
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3551
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Country | US
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Telephone | 317-824-9361
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Fax | 317-219-0827
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Authorized Official
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Title or Position | CLINICIAN
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Name | CHESNEY COLEMAN-MILLER
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Credential | LCSW
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Telephone | 317-824-9361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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