Individual
CARL HEDELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39000921A
IN
1041C0700X
Clinical Social Worker
Primary
34002910A
IN
106H00000X
Marriage & Family Therapist
35000354A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000205754
ANTHEM BCBS PROVIDER PIN
IN
Enumeration date
05/15/2006
Last updated
07/26/2007
Update your record
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