MEDICARE: CARACONNECT COUNSELING LLC

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	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326758558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARACONNECT COUNSELING LLC

Provider Business Mailing Address
First Line	:	607 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6706
Country	:	US
Telephone Number	:	260-200-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6706
Country	:	US
Telephone Number	:	260-200-3223
Fax Number	:	260-264-5366

Authorized Official
Title or Position	:	RENDERING PROVIDER
Name	:	ELIZABETH A WHITAKER
Credential	:	LMHC
Telephone Number	:	614-774-8307

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	11/29/2022

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