MEDICARE: H.O.P.E. COUNSELING SERVICES

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	251S00000X	Community/Behavioral Health Agency	1410-0-ASO	IN

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	:	1386837938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H.O.P.E. COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	1984 INDIANAPOLIS RD
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-3135
Country	:	US
Telephone Number	:	765-364-0380
Fax Number	:	765-364-6816

Provider Business Practice Location Address
First Line	:	1984 INDIANAPOLIS RD
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-3135
Country	:	US
Telephone Number	:	765-364-0380
Fax Number	:	765-364-6816

Authorized Official
Title or Position	:	OWNER/LEAD THERAPIST
Name	:	DR. MARY KATHLEEN LICHTENWALTER
Credential	:	MS, PHD
Telephone Number	:	765-364-0380

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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