First Church of Deliverance and Recovery Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

FIRST CHURCH OF DELIVERANCE AND RECOVERY INC.

Practice address

1424 N Tibbs Ave
Indianapolis, IN 46222-3026

Phone

(317) 602-5908

NPI assigned

Jun 27, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Felicia Ann Smith, MENTAL HEALTH

Title

Program Director

Phone

(317) 679-2311

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1942795406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 N TIBBS AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462223026",
            "telephone_number": "317-602-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 N TIBBS AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462223026",
            "telephone_number": "317-602-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CHURCH OF DELIVERANCE AND RECOVERY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-27",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "FELICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "317-679-2311",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MENTAL HEALTH"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300005347",
            "state": "IN"
        }
    ],
    "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 Jun 27, 2018; 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.