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General NPI Number Information
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NPI Number | 1730890690
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Entity Type | Organization
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Legal Business Name | LIFESTORY COLLABORATIVE COUNSELING LLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 941 E 86TH ST STE 120
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1842
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Country | US
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Telephone | 317-854-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 941 E 86TH ST STE 120
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1842
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Country | US
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Telephone | 317-854-9790
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Fax |
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Authorized Official
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Title or Position | OWNER, SOLE MEMBER
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Name | CYNTHIA DROUIN
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Credential | LMHC
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Telephone | 317-502-5760
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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 |
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License Number State |
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