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NPI Code Detail

MEDICARE: CIRCLE CITY BEHAVIORAL HEALTH LLC

MEDICARE: CIRCLE CITY BEHAVIORAL HEALTH 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 : 1982387742
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIRCLE CITY BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 706 LEXINGTON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1045
Country : US
Telephone Number : 317-279-4003
Fax Number :
Provider Business Practice Location Address
First Line : 706 LEXINGTON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1045
Country : US
Telephone Number : 317-279-4003
Fax Number :
Authorized Official
Title or Position : FOUNDER
Name : MILAN NGUYEN
Credential : LCSW
Telephone Number : 317-730-7403
Provider Enumeration Date : 08/09/2023
Last Update Date : 08/09/2023

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Directions to “CIRCLE CITY BEHAVIORAL HEALTH LLC ” Practice Location

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