Basic Information
| Provider Information | |||||||||
| NPI: | 1750036000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATALYST COUNSELING & CONSULTING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 429 E VERMONT ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462023688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122305106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 429 E VERMONT ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462023688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122305106 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHURCH | ||||||||
| AuthorizedOfficialFirstName: | SARA | ||||||||
| AuthorizedOfficialMiddleName: | RAE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8122305106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC CMIP | ||||||||
| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1730442161 | 01 | IN | NATIONAL PROVIDER SYSTEM | OTHER |