# RENAE CLARK-WEATHERLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275043069
- **Authorized official:** RENAE CLARK-WEATHERLY MA (THERAPIST)
- **Authorized official phone:** (317) 222-9704

## Contact information

- **Practice address:** 4126 E 10TH ST, INDIANAPOLIS, IN 46201-2613
- **Practice address phone:** (317) 686-0931
- **Practice address fax:** (866) 406-5077
- **Mailing address:** 5126 GUION RD, INDIANAPOLIS, IN 46254-1725
- **Mailing address phone:** (317) 222-9704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | 99064493A | IN | Yes |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | 99074128A | IN | — |

## Other

- **Enumeration date:** 10/05/2017
- **Last updated:** 09/01/2024