MEDICARE: FAMILY AND COMMUNITY SOLUTIONS INC

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	35001938A	IN
2	103T00000X	Psychologist	20010499A	IN

General Provider Information

NPI Number	:	1346784626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY AND COMMUNITY SOLUTIONS INC

Provider Business Mailing Address
First Line	:	6437 RUCKER RD STE E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4868
Country	:	US
Telephone Number	:	317-679-4181
Fax Number	:

Provider Business Practice Location Address
First Line	:	6437 RUCKER RD STE E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4868
Country	:	US
Telephone Number	:	317-679-4181
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH EVERETT
Credential	:	LMFT
Telephone Number	:	317-679-4181

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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