=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902624398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALM THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2024
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 FOUNDRY DR STE 1200
-----------------------------------------------------
City | WEST LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47906-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-404-6025
-----------------------------------------------------
Fax | 765-340-8075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 FOUNDRY DR STE 1200
-----------------------------------------------------
City | WEST LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47906-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-404-6025
-----------------------------------------------------
Fax | 765-340-8075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | AMANDA MILSAP
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 765-404-6025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------