MEDICARE: KELLY CREMEANS LMFT

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	35001608A	IN

General Provider Information

NPI Number	:	1467586347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CREMEANS LMFT

Provider Business Mailing Address
First Line	:	2680 E MAIN ST
Second Line	:	SUITE 209
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2825
Country	:	US
Telephone Number	:	317-797-7185
Fax Number	:	317-203-0840

Provider Business Practice Location Address
First Line	:	2680 E MAIN ST
Second Line	:	SUITE 209
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2825
Country	:	US
Telephone Number	:	317-797-7185
Fax Number	:	317-203-0840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/12/2024

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