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Organization

MAPLE CITY COUNSELING CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KEITH DD JODWAY LMHC, LCAC (OWNER)
(574) 220-0220
Entity
Organization

Contact information

Practice address
209 TANGLEWOOD DR APT C, GOSHEN, IN 46526-1718
(574) 220-0220
(574) 975-7788
Mailing address
209 TANGLEWOOD DR APT C, GOSHEN, IN 46526-1718
(574) 220-0220
(574) 975-7788

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
39001485A
LICENSED MENTAL HEALTH COUNSELOR
IN
01
87000367A
LICENSED CLINICAL ADDICTION COUNSELOR
IN
Enumeration date
05/13/2019
Last updated
05/13/2019
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