MEDICARE: ALLEN'S THERAPEUTIC SERVICES 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	34003862A	IN

General Provider Information

NPI Number	:	1689034571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN'S THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	5455 W 86TH ST STE 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1504
Country	:	US
Telephone Number	:	317-820-3600
Fax Number	:	317-663-0914

Provider Business Practice Location Address
First Line	:	5455 W 86TH ST STE 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1504
Country	:	US
Telephone Number	:	317-820-3600
Fax Number	:	317-663-0914

Authorized Official
Title or Position	:	OWNER
Name	:	ALLEN M RADER
Credential	:	LCSW
Telephone Number	:	317-446-5676

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	12/03/2020

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