Provider Demographics
NPI:1114349081
Name:NORVELL, ROY (MS, LCAC)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:NORVELL
Suffix:
Gender:M
Credentials:MS, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1020
Mailing Address - Country:US
Mailing Address - Phone:317-686-5800
Mailing Address - Fax:317-686-5810
Practice Address - Street 1:927 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1020
Practice Address - Country:US
Practice Address - Phone:317-686-5800
Practice Address - Fax:317-686-5810
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN870790A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)