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General NPI Number Information
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NPI Number | 1699368795
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Entity Type | Organization
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Legal Business Name | SYCAMORE FAMILY SERVICES OF INDIANA
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 3445 W 71ST STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 46268
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Country | US
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Telephone | 317-937-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 4119 LONGWOOD CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46268
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Country | US
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Telephone | 317-937-1122
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JACQUELYN ELAINE POWELL
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Credential | LCAC, LMHC
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Telephone | 317-371-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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