MEDICARE: COUNSELING PARTNERS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
5	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1326387523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING PARTNERS LLC

Provider Business Mailing Address
First Line	:	115 FARABEE DR N
Second Line	:	SUITE B2
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5913
Country	:	US
Telephone Number	:	765-427-6756
Fax Number	:	765-423-5600

Provider Business Practice Location Address
First Line	:	115 FARABEE DR N
Second Line	:	SUITE B2
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5913
Country	:	US
Telephone Number	:	765-427-6756
Fax Number	:	765-423-5600

Authorized Official
Title or Position	:	CEO
Name	:	MRS. VIVIAN LEUCK
Credential	:	MS
Telephone Number	:	765-427-6756

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	02/07/2013

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Directions to “COUNSELING PARTNERS LLC ” Practice Location

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