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NPI Code Detail

MEDICARE: BE AUTHENTIC INDY LLC

MEDICARE: BE AUTHENTIC INDY 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1841901022
Entity Type Code : Organization
Provider Name (Legal Business Name) : BE AUTHENTIC INDY LLC
Provider Business Mailing Address
First Line : 11005 THUNDERBIRD DR
Second Line :
City : CARMEL
State : IN
Zip : 46032-7912
Country : US
Telephone Number : 646-241-6260
Fax Number :
Provider Business Practice Location Address
First Line : 8606 ALLISONVILLE RD STE 120
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-3585
Country : US
Telephone Number : 317-548-8895
Fax Number : 317-663-2524
Authorized Official
Title or Position : OWNER
Name : TARA ENGLAND
Credential :
Telephone Number : 646-241-6260
Provider Enumeration Date : 12/08/2022
Last Update Date : 03/20/2025

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Directions to “BE AUTHENTIC INDY LLC ” Practice Location

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