Basic Information
| Provider Information | |||||||||
| NPI: | 1568993269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMOS | ||||||||
| FirstName: | TED | ||||||||
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| Credential: | MDIV. LMFT CSAYC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4319 E 56TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462205776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177757976 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5638 PROFESSIONAL CIR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887141927 | ||||||||
| FaxNumber: | 3172478935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 05/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35001925 | IN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.