Branches of Life Family Connections

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BRANCHES OF LIFE FAMILY CONNECTIONS

Practice address

4954 E 56TH St
#10
Indianapolis, IN 46220-5773

Phone

(317) 449-0334

Fax

(317) 536-1070

NPI assigned

Feb 3, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Shannon M Dickerson, M.S

Title

President/Therapist

Phone

(317) 446-4943

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1366680902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 E 56TH ST",
            "address_2": "#10",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462205773",
            "telephone_number": "317-449-0334",
            "fax_number": "317-536-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4954 E 56TH ST",
            "address_2": "#10",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462205773",
            "telephone_number": "317-449-0334",
            "fax_number": "317-536-1070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANCHES OF LIFE FAMILY CONNECTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-03",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/THERAPIST",
        "authorized_official_telephone_number": "317-446-4943",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Indianapolis, IN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.