Provider Demographics
NPI:1235151333
Name:SCULLY, JOYCE
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:SCULLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SKI HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IL
Mailing Address - Zip Code:44636
Mailing Address - Country:US
Mailing Address - Phone:219-781-7198
Mailing Address - Fax:219-763-7792
Practice Address - Street 1:78 SKI HILL RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-8719
Practice Address - Country:US
Practice Address - Phone:219-781-7198
Practice Address - Fax:219-763-7792
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist