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General NPI Number Information
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NPI Number | 1770065153
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Entity Type | Organization
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Legal Business Name | IN TIME CREATIVE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 619 CHERRY ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-3125
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Country | US
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Telephone | 812-382-5512
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Fax | 812-244-2762
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Provider Business Mailing Address
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Address Line | 5105 S. US HWY 41 PMB 227
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4790
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Country | US
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Telephone | 812-382-5512
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. THERESA WHITE
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Credential | LMHC, NCC, CCMHC
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Telephone | 812-208-3175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 390002582A
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License Number State | IN
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Taxonomy #2
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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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