Provider Demographics
NPI:1235304734
Name:JOEY SOMERS O'DONNELL, PSY.D., LLC
Entity Type:Organization
Organization Name:JOEY SOMERS O'DONNELL, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:317-408-9560
Mailing Address - Street 1:50 E 91ST ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1549
Mailing Address - Country:US
Mailing Address - Phone:317-408-9560
Mailing Address - Fax:
Practice Address - Street 1:50 E. 91ST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1549
Practice Address - Country:US
Practice Address - Phone:317-408-9560
Practice Address - Fax:866-855-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041754A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty