MEDICARE: COMMUNITY OUTREACH NETWORK SERVICES, 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	251S00000X	Community/Behavioral Health Agency	1681-0-ASO	IN

General Provider Information

NPI Number	:	1568867026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OUTREACH NETWORK SERVICES, INC.

Provider Business Mailing Address
First Line	:	2105 N. MERIDIAN ST.
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1338
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

Provider Business Practice Location Address
First Line	:	2105 N MERIDIAN ST
Second Line	:	SUITE 102
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1491
Country	:	US
Telephone Number	:	317-926-5463
Fax Number	:	317-926-5498

Authorized Official
Title or Position	:	EXECUTIVE/CLINICAL DIRECTOR
Name	:	SHEILA COLLEEN WILLIAMSON
Credential	:	LMHC, LCAC
Telephone Number	:	317-926-5463

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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