Provider Demographics
NPI:1205030954
Name:CHRISTIAN THEOLOGICAL SEMINARY
Entity Type:Organization
Organization Name:CHRISTIAN THEOLOGICAL SEMINARY
Other - Org Name:COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-955-2499
Mailing Address - Street 1:1000 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3301
Mailing Address - Country:US
Mailing Address - Phone:317-924-5205
Mailing Address - Fax:317-931-2393
Practice Address - Street 1:1050 W 42ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3301
Practice Address - Country:US
Practice Address - Phone:317-924-5205
Practice Address - Fax:317-931-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019810A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196670AMedicaid
IN000000216006OtherANTHEM GROUP NUMBER
IN200196670AMedicaid