| Collaborative Change Llc | |
|
1060 E Main St # S401 Brownsburg IN 46112-1408 | |
| (317) 296-4187 | |
| (317) 203-0995 |
| Full Name | Collaborative Change Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1060 E Main St # S401, Brownsburg, Indiana |
| Authorized Official Name and Position | Babe Black (OWNER) |
| Authorized Official Contact | 3172259483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Collaborative Change Llc 8331 Crawfordsville Rd Indianapolis IN 46234-7740 Ph: (317) 296-4187 | Collaborative Change Llc 1060 E Main St # S401 Brownsburg IN 46112-1408 Ph: (317) 296-4187 |
| NPI Number | 1770916587 |
|---|---|
| Provider Enumeration Date | 08/15/2013 |
| Last Update Date | 05/04/2022 |
| Certification Date | 05/04/2022 |
| Medicare PECOS PAC ID | 5193045987 |
|---|---|
| Medicare Enrollment ID | O20150519000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770916587 | NPI | - | NPPES |
| 20119194A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34005850A (Indiana) | Primary |
| Provider Name | Babe A Black |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114145513 PECOS PAC ID: 7315267101 Enrollment ID: I20150521001859 |
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