MEDICARE: SOUNDBOARD THERAPY 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

General Provider Information

NPI Number	:	1992667687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUNDBOARD THERAPY LLC

Provider Business Mailing Address
First Line	:	234 CALIFORNIA ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6826
Country	:	US
Telephone Number	:	812-721-2757
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 CALIFORNIA ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6826
Country	:	US
Telephone Number	:	812-721-2757
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CATELYN MITCHELL
Credential	:	LCSW
Telephone Number	:	812-721-2757

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/09/2025

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