MEDICARE: ABC COUNSELING, 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	1041C0700X	Clinical Social Worker	33006408A	IN

General Provider Information

NPI Number	:	1780052928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC COUNSELING, LLC

Provider Business Mailing Address
First Line	:	6526 HILLSBORO LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1821
Country	:	US
Telephone Number	:	260-494-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	6526 HILLSBORO LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1821
Country	:	US
Telephone Number	:	260-494-2205
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ALIA DAWN OSBORN
Credential	:	LCSW
Telephone Number	:	260-494-2205

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/03/2015

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