Basic Information
Provider Information
NPI: 1104881689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARTINGTON
FirstName: CONNIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 720 N MARR RD
Address2:  
City: COLUMBUS
State: IN
PostalCode: 472016660
CountryCode: US
TelephoneNumber: 8123143400
FaxNumber: 8123788367
Practice Location
Address1: 3008 BEVCHER DR
Address2:  
City: MADISON
State: IN
PostalCode: 472503863
CountryCode: US
TelephoneNumber: 8122651918
FaxNumber: 8122651828
Other Information
ProviderEnumerationDate: 04/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home