1497132179 NPI number — STRATEGIC COACHING AND THERAPIES LLC

Table of content: (NPI 1497132179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497132179 NPI number — STRATEGIC COACHING AND THERAPIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATEGIC COACHING AND THERAPIES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497132179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8872 CRYSTAL RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46240-6434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-218-3479
Provider Business Mailing Address Fax Number:
317-816-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3815 RIVER CROSSING PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46240-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-847-2244
Provider Business Practice Location Address Fax Number:
317-816-7001
Provider Enumeration Date:
05/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JUERGENSEN SHEETS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-218-3479

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  350001957A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com