MEDICARE: SOARING HEART COUNSELING

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	34005787A	IN

General Provider Information

NPI Number	:	1689108219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOARING HEART COUNSELING

Provider Business Mailing Address
First Line	:	819 E 64TH ST
Second Line	:	STE 242
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 E 64TH ST
Second Line	:	STE 242
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1671
Country	:	US
Telephone Number	:	317-670-8200
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. KATHY G SLAUGHTER
Credential	:	LCSW
Telephone Number	:	317-670-8200

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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