Provider Demographics
NPI:1033394101
Name:ANGELA R MARSHALL PSYD INC
Entity Type:Organization
Organization Name:ANGELA R MARSHALL PSYD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GODSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-824-8787
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47458-0096
Mailing Address - Country:US
Mailing Address - Phone:812-824-8787
Mailing Address - Fax:812-824-8825
Practice Address - Street 1:2525 W VERNAL PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2782
Practice Address - Country:US
Practice Address - Phone:812-345-5114
Practice Address - Fax:812-339-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041898A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232480Medicare PIN