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General NPI Number Information
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NPI Number | 1902412398
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Entity Type | Organization
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Legal Business Name | ACES CLINIC, LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 120 W 7TH ST STE 104
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3835
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Country | US
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Telephone | 812-671-2688
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 S DALE CT
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City | BLOOMINGTON
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State | IN
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Zip | 47401-2414
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | JENNIFER HALLORAN
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Credential |
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Telephone | 812-671-2688
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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 |
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License Number State |
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