Provider Demographics
NPI:1053857821
Name:QUALIFE PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:QUALIFE PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRICHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:317-528-9110
Mailing Address - Street 1:6544 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1178
Mailing Address - Country:US
Mailing Address - Phone:317-528-9110
Mailing Address - Fax:
Practice Address - Street 1:6544 FERGUSON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1178
Practice Address - Country:US
Practice Address - Phone:317-528-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042554A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty