NPIMap

Organization Active NPI

Brooke's Place for Grieving Young People

  • Mental Health Counselor
  • Indianapolis, IN
National Provider Identifier
1194958470
Registry record updated Oct 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39000529A Issued in IN
Legal business name
BROOKE'S PLACE FOR GRIEVING YOUNG PEOPLE
Practice address
50 E 91St St
Ste. 103
Indianapolis, IN 46240-1549
Phone
(317) 705-9650
Fax
(317) 705-9654
NPI assigned
Sep 2, 2009
Last updated
Oct 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carol Braden, LMHC
Title
Executive Program Director
Phone
(317) 705-9650

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 39001577A IN
Mental Health Counselor 101YM0800X 39000529A IN Primary
Clinical Social Worker 1041C0700X 34003076A IN
Clinical Social Worker 1041C0700X 34005191A IN

Addresses

Primary practice location

50 E 91St St
Ste. 103
Indianapolis, IN 46240-1549

Mailing address

50 E 91St St
Ste. 103
Indianapolis, IN 46240-1549
Phone (317) 705-9650

National Provider Directory

National Provider Directory

Locations

50 E 91st St
Ste 103
Indianapolis, IN 46240
Phone (317) 705-9650

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255996800000",
    "number": "1194958470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E 91ST ST",
            "address_2": "STE. 103",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401549",
            "telephone_number": "317-705-9650",
            "fax_number": "317-705-9654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E 91ST ST",
            "address_2": "STE. 103",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401549",
            "telephone_number": "317-705-9650",
            "fax_number": "317-705-9654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKE'S PLACE FOR GRIEVING YOUNG PEOPLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-02",
        "last_updated": "2009-10-20",
        "status": "A",
        "authorized_official_last_name": "BRADEN",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "EXECUTIVE PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "317-705-9650",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39001577A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39000529A",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34003076A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005191A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.