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General NPI Number Information
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NPI Number | 1780946269
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Entity Type | Organization
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Legal Business Name | TAKE BACK CONTROL LLC
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 55 1/2 E COURT ST
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City | FRANKLIN
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State | IN
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Zip | 46131-2303
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Country | US
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Telephone | 317-346-4000
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Fax | 317-346-0442
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Provider Business Mailing Address
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Address Line | 3445 W 71ST ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2248
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Country | US
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Telephone | 317-346-4000
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Fax | 317-346-0442
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. YOLANDA RENEE' REEVES
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Credential | BSW, MA, LCAC
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Telephone | 317-346-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 87000158A
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License Number State | IN
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