Provider Demographics
NPI:1528335924
Name:BIOFEEDBACK COUNSELING CENTER
Entity type:Organization
Organization Name:BIOFEEDBACK COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANGEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAC
Authorized Official - Phone:502-641-5989
Mailing Address - Street 1:9451 VOYLES RD
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IN
Mailing Address - Zip Code:47165-9606
Mailing Address - Country:US
Mailing Address - Phone:502-641-5989
Mailing Address - Fax:
Practice Address - Street 1:2580 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2555
Practice Address - Country:US
Practice Address - Phone:502-641-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001748A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)