Basic Information
| Provider Information | |||||||||
| NPI: | 1770128050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFINITY MENTAL HEALTH SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 DIRECTORS ROW STE C | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462414936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174504801 | ||||||||
| FaxNumber: | 3179696727 | ||||||||
| Practice Location | |||||||||
| Address1: | 1108 KINGWOOD DR | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461235500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172041100 | ||||||||
| FaxNumber: | 3172717054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2019 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | HAILEY | ||||||||
| AuthorizedOfficialMiddleName: | BRIANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3174504801 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.