Basic Information
Provider Information | |||||||||
NPI: | 1649629981 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAWTHON | ||||||||
FirstName: | HALEY | ||||||||
MiddleName: | MICHELE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW, LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STOUT | ||||||||
OtherFirstName: | HALEY | ||||||||
OtherMiddleName: | MICHELE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5101 E US HIGHWAY 36 STE 100 | ||||||||
Address2: |   | ||||||||
City: | AVON | ||||||||
State: | IN | ||||||||
PostalCode: | 461236646 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8887141927 | ||||||||
FaxNumber: | 3177459565 | ||||||||
Practice Location | |||||||||
Address1: | 5638 PROFESSIONAL CIR | ||||||||
Address2: |   | ||||||||
City: | INDIANAPOLIS | ||||||||
State: | IN | ||||||||
PostalCode: | 462415042 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8887141927 | ||||||||
FaxNumber: | 3172478935 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2016 | ||||||||
LastUpdateDate: | 02/07/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X |   |   | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | 34008379A | IN | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.