MEDICARE: LAURA ROSE EICHENBERGER LMFT

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	106H00000X	Marriage & Family Therapist	35002333A	IN

General Provider Information

NPI Number	:	1225812795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROSE EICHENBERGER LMFT

Provider Business Mailing Address
First Line	:	8180 CLEARVISTA PKWY STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4622
Country	:	US
Telephone Number	:	317-355-2560
Fax Number	:

Provider Business Practice Location Address
First Line	:	8180 CLEARVISTA PKWY STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4622
Country	:	US
Telephone Number	:	317-355-2560
Fax Number	:

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

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/24/2023

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