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General NPI Number Information
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NPI Number | 1942896428
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Entity Type | Organization
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Legal Business Name | COUNSELING AT THE GREEN HOUSE
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 447 E 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2622
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Country | US
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Telephone | 317-455-5642
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Fax |
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Provider Business Mailing Address
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Address Line | 447 E 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-2622
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Country | US
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Telephone | 317-455-5642
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Fax |
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Authorized Official
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Title or Position | FOUNDER & DIRECTOR
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Name | BROOKE RANDOLPH
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Credential | LMHC
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Telephone | 317-455-5642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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