Provider Demographics
NPI:1275613341
Name:LINK PSYCHOLOGICAL & CONSULTING SERV
Entity Type:Organization
Organization Name:LINK PSYCHOLOGICAL & CONSULTING SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:219-324-7063
Mailing Address - Street 1:213 FARMWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-1905
Mailing Address - Country:US
Mailing Address - Phone:219-324-7063
Mailing Address - Fax:219-362-1962
Practice Address - Street 1:900 I STREET
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5533
Practice Address - Country:US
Practice Address - Phone:219-324-7063
Practice Address - Fax:219-362-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041588A103T00000X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200297340AMedicaid
IN200297340 AMedicaid
IN193200Medicare UPIN
IN200297340 AMedicaid