Individual
KELLY NADINE SOFORIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5100
Mailing address
6626 E 75TH STREET, STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7561
(317) 355-6096
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000080A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000864011
ANTHEM
IN
01
—
164067
VALUE OPTIONS
IN
Enumeration date
03/23/2007
Last updated
12/29/2021
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