Organization
PSYCHOTHERAPY ASSOCIATES OF KOKOMO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY THOMAS ANTONELLI III LCSW, LCAC (CEO/PSYCHOTHERAPIST)
(765) 480-0594
Entity
Organization
Contact information
Practice address
217 E SOUTHWAY BLVD STE 101, KOKOMO, IN 46902-3577
(765) 480-0594
Mailing address
217 E SOUTHWAY BLVD STE 101, KOKOMO, IN 46902-3577
(765) 480-0594
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
1041S0200X
School Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
07/21/2020
Last updated
07/21/2020
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