Provider Demographics
NPI:1528842069
Name:CONSCIOUSLY OVERCOMING POWERFUL EMOTIONS LLC
Entity type:Organization
Organization Name:CONSCIOUSLY OVERCOMING POWERFUL EMOTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAKETA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:219-201-1852
Mailing Address - Street 1:10604 ONTARIO DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7654
Mailing Address - Country:US
Mailing Address - Phone:219-201-1852
Mailing Address - Fax:
Practice Address - Street 1:8220 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1704
Practice Address - Country:US
Practice Address - Phone:219-201-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty