Basic Information
| Provider Information | |||||||||
| NPI: | 1245367820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAEFNITZ | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| OtherLastName: | GRAEFNITZ | ||||||||
| OtherFirstName: | LAURIE | ||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | STE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656594771 | ||||||||
| FaxNumber: | 7656599473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 34005416A | IN | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 34005416A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.