MEDICARE: T.R.I.P. MENTORING 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1992935803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.R.I.P. MENTORING LLC

Provider Business Mailing Address
First Line	:	7526 N AUDUBON RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2359
Country	:	US
Telephone Number	:	317-532-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	7526 N AUDUBON RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2359
Country	:	US
Telephone Number	:	317-532-7176
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	FLETCHER TRIPLETT
Credential	:
Telephone Number	:	317-532-7176

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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