MEDICARE: MR. NORMAN EARL MINOR JR. LCSW

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	1041C0700X	Clinical Social Worker	34004298A	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	:	1598764581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORMAN EARL MINOR JR. LCSW

Provider Business Mailing Address
First Line	:	550 N. UNIVERSITY BLVD
Second Line	:	ROOM 2155
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5149
Country	:	US
Telephone Number	:	317-944-2344
Fax Number	:	317-948-9265

Provider Business Practice Location Address
First Line	:	550 N. UNIVERSITY BLVD
Second Line	:	ROOM 2155
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5149
Country	:	US
Telephone Number	:	317-944-2344
Fax Number	:	317-948-9265

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/15/2012

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