MEDICARE: DAVI STEIN-KILEY LCSW, LMFT, LCAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000904A	IN
2	106H00000X	Marriage & Family Therapist	35000161A	IN
3	1041C0700X	Clinical Social Worker	34002439A	IN

General Provider Information

NPI Number	:	1790316644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVI STEIN-KILEY LCSW, LMFT, LCAC

Provider Business Mailing Address
First Line	:	2680 E MAIN ST STE 500
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2949
Country	:	US
Telephone Number	:	812-550-5849
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 E MAIN ST STE 500
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2949
Country	:	US
Telephone Number	:	317-663-9802
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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