Provider Demographics
NPI:1992936223
Name:ABBA FATHERS CREATIONS CORP
Entity type:Organization
Organization Name:ABBA FATHERS CREATIONS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LUANNE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA,MA,MS
Authorized Official - Phone:317-660-2157
Mailing Address - Street 1:120 E MARKET ST STE 460
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3282
Mailing Address - Country:US
Mailing Address - Phone:317-660-2157
Mailing Address - Fax:317-362-0460
Practice Address - Street 1:120 E MARKET ST STE 460
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3282
Practice Address - Country:US
Practice Address - Phone:317-660-2157
Practice Address - Fax:317-362-0460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBA FATHERS CREATIONS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty