Basic Information
| Provider Information | |||||||||
| NPI: | 1730196916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUVILLION | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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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: | 08/01/2006 | ||||||||
| LastUpdateDate: | 03/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 20010261 | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 100064690A | 05 | IN | MEDICAID |