Basic Information
| Provider Information | |||||||||
| NPI: | 1982600029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARKISSIAN | ||||||||
| FirstName: | ARMEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | EDD, HSPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6655 E US HIGHWAY 36 | ||||||||
| Address2: | CUMMINS BEHAVIORAL HEALTH SYSTEMS INC | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172723330 | ||||||||
| FaxNumber: | 3172723331 | ||||||||
| Practice Location | |||||||||
| Address1: | 6655 E US HIGHWAY 36 | ||||||||
| Address2: | CUMMINS BEHAVIORAL HEALTH SYSTEMS INC | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172723330 | ||||||||
| FaxNumber: | 3172723331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 20040104A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 000000489063 | 01 | IN | ANTHEM BCBS PROVIDER PIN | OTHER | 100336930A | 05 | IN | MEDICAID |