MEDICARE: MR. GERALD CARTER LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	33009386A	IN

General Provider Information

NPI Number	:	1154945954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD CARTER LSW

Provider Business Mailing Address
First Line	:	CARTER COUNSELING SERVICES LLC, 1387 N SHADELAND AVE
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219
Country	:	US
Telephone Number	:	317-625-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1387 N SHADELAND AVE STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3605
Country	:	US
Telephone Number	:	317-625-0217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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