MEDICARE: IN-DEPTH THERAPY 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568300937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN-DEPTH THERAPY LLC

Provider Business Mailing Address
First Line	:	12 ROSELAWN CT UNIT A
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-6342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 ROSELAWN CT UNIT A
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-6342
Country	:	US
Telephone Number	:	831-869-9442
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JUSTIN DOOLITTLE
Credential	:
Telephone Number	:	831-869-9442

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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