MEDICARE: ANNIE SEBRING

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	39001269A	IN
2	101YP1600X	Pastoral Counselor	39001269A	IN
3	101YP2500X	Professional Counselor	39001269A	IN
4	106H00000X	Marriage & Family Therapist	35000446A	IN

General Provider Information

NPI Number	:	1649245275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE SEBRING

Provider Business Mailing Address
First Line	:	850 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1098
Country	:	US
Telephone Number	:	317-554-2702
Fax Number	:	317-554-6541

Provider Business Practice Location Address
First Line	:	1001 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2859
Country	:	US
Telephone Number	:	317-630-8485
Fax Number	:	317-630-7616

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/30/2007

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Directions to “ ANNIE SEBRING ” Practice Location

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