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NPI Code Detail

MEDICARE: MENTAL HEALTH ASSOCIATION IN INDIANA, INC.

MEDICARE: MENTAL HEALTH ASSOCIATION IN INDIANA, 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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker
3106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1497030662
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENTAL HEALTH ASSOCIATION IN INDIANA, INC.
Provider Business Mailing Address
First Line : 1431 N DELAWARE ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2416
Country : US
Telephone Number : 317-638-3501
Fax Number : 317-638-6540
Provider Business Practice Location Address
First Line : 1431 N DELAWARE ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2416
Country : US
Telephone Number : 317-638-3501
Fax Number : 317-638-6540
Authorized Official
Title or Position : PRESIDENT
Name : ELIZABETH KARNES
Credential : CPA
Telephone Number : 317-638-3501
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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