MEDICARE: CAROL LYNNE HORNBECK LFMT

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	35001647A	IN

General Provider Information

NPI Number	:	1639333503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LYNNE HORNBECK LFMT

Provider Business Mailing Address
First Line	:	7700 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-3652
Country	:	US
Telephone Number	:	317-252-5518
Fax Number	:	317-259-5718

Provider Business Practice Location Address
First Line	:	7700 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-3652
Country	:	US
Telephone Number	:	317-252-5518
Fax Number	:	317-259-5718

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

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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