Provider Demographics
NPI:1861589012
Name:AGAPE COUNSELING AND HUMAN SERVICES, LLC
Entity type:Organization
Organization Name:AGAPE COUNSELING AND HUMAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:317-889-7520
Mailing Address - Street 1:5150 E STOP 11 RD STE 14
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8629
Mailing Address - Country:US
Mailing Address - Phone:317-889-7520
Mailing Address - Fax:317-881-6450
Practice Address - Street 1:5150 E STOP 11 RD STE 14
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8629
Practice Address - Country:US
Practice Address - Phone:317-889-7520
Practice Address - Fax:317-881-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200372510Medicaid