Provider Demographics
NPI:1215201926
Name:SHINING TIMES PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SHINING TIMES PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CHILD PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:CONLEY-GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSPP
Authorized Official - Phone:317-566-2814
Mailing Address - Street 1:3077 E 98TH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2940
Mailing Address - Country:US
Mailing Address - Phone:317-566-2814
Mailing Address - Fax:317-566-2815
Practice Address - Street 1:3077 E 98TH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2940
Practice Address - Country:US
Practice Address - Phone:317-566-2814
Practice Address - Fax:317-566-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health