Individual
MR. KERRY MINNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LMFT, LCAC
Contact information
Practice address
610 E SOUTHPORT RD, SUITE 100, INDIANAPOLIS, IN 46227-8581
(317) 783-8477
Mailing address
10155 E THOMPSON RD, INDIANAPOLIS, IN 46239-9350
(317) 862-1821
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000437A
IN
1041C0700X
Clinical Social Worker
Primary
34000534A
IN
106H00000X
Marriage & Family Therapist
35000242A
IN
Other
Enumeration date
03/11/2007
Last updated
08/19/2013
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