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200 Ferry St Suite K Lafayette IN 47901-1172 | |
| (765) 428-8108 | |
| (765) 429-7088 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 200 Ferry St, Lafayette, Indiana |
| Authorized Official Name and Position | Joann Hiscox (OWNER) |
| Authorized Official Contact | 7654288108 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
200 Ferry St Suite K Lafayette IN 47901-1172 Ph: (765) 428-8108 | 200 Ferry St Suite K Lafayette IN 47901-1172 Ph: (765) 428-8108 |
| NPI Number | 1407979917 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 06/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407979917 | NPI | - | NPPES |
| 200336200A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 39000412A (Indiana) | Primary |
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