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General NPI Number Information
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NPI Number | 1841009347
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Entity Type | Organization
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Legal Business Name | MIDWEST COUNSELING CENTER IN, LLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 777 E MAIN ST
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City | WESTFIELD
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State | IN
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Zip | 46074-5300
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Country | US
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Telephone | 781-558-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 15813 72ND AVE FL 2
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-4100
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Country | US
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Telephone | 716-819-0392
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHRISTOPHER FOSTER
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Credential |
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Telephone | 781-558-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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