Provider Demographics
NPI:1003152901
Name:RADEL, MARK P (MA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:RADEL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1305
Mailing Address - Country:US
Mailing Address - Phone:317-924-7010
Mailing Address - Fax:317-941-2208
Practice Address - Street 1:2011 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1305
Practice Address - Country:US
Practice Address - Phone:317-924-7010
Practice Address - Fax:317-941-2208
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health