Basic Information
| Provider Information | |||||||||
| NPI: | 1124176961 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL PSYCHOLOGICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10293 N MERIDIAN ST | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462901123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175812288 | ||||||||
| FaxNumber: | 3175812295 | ||||||||
| Practice Location | |||||||||
| Address1: | 10293 N MERIDIAN ST | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462901123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175812288 | ||||||||
| FaxNumber: | 3175812295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | COUVILLION | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3175812288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.