Provider Demographics
NPI:1063689545
Name:GIGI P STOWE PHD PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:GIGI P STOWE PHD PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:PINNELL
Authorized Official - Last Name:STOWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:812-961-3837
Mailing Address - Street 1:101 W KIRKWOOD AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6129
Mailing Address - Country:US
Mailing Address - Phone:812-961-3837
Mailing Address - Fax:
Practice Address - Street 1:101 W KIRKWOOD AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6129
Practice Address - Country:US
Practice Address - Phone:812-961-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042141A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200920520Medicaid
259120Medicare PIN