MEDICARE: BOARD OF FUNDAMENTAL EDUCATION 'BFE'

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251300000X	Local Education Agency (LEA)
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1265724371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF FUNDAMENTAL EDUCATION 'BFE'

Provider Business Mailing Address
First Line	:	5210 MAROTT CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1541
Country	:	US
Telephone Number	:	317-412-8358
Fax Number	:	317-733-9833

Provider Business Practice Location Address
First Line	:	5210 MAROTT CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1541
Country	:	US
Telephone Number	:	317-412-8531
Fax Number	:	317-733-9833

Authorized Official
Title or Position	:	CEO
Name	:	CAROL WOODARD
Credential	:
Telephone Number	:	317-412-8358

Provider Enumeration Date	:	05/07/2011
Last Update Date	:	06/15/2011

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