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STACEY J COGHILL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMHC

Contact information

Practice address
950 N MERIDIAN ST, INDIANAPOLIS, IN 46204-1077
(317) 963-2200
(317) 963-1621
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003081A
IN
101YP2500X
Professional Counselor
39003081A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300054495
IN
Enumeration date
11/05/2018
Last updated
02/13/2024
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