Provider Demographics
NPI:1801084579
Name:CARMEL COUNSELING GROUP LLC
Entity type:Organization
Organization Name:CARMEL COUNSELING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-440-4176
Mailing Address - Street 1:654 OVERCUP ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5803
Mailing Address - Country:US
Mailing Address - Phone:317-440-4176
Mailing Address - Fax:775-288-3479
Practice Address - Street 1:13295 ILLINOIS ST
Practice Address - Street 2:SUITE 311
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3019
Practice Address - Country:US
Practice Address - Phone:317-440-4176
Practice Address - Fax:775-288-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001720A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health