Provider Demographics
NPI:1396824694
Name:CLINICAL PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUESCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-736-0003
Mailing Address - Street 1:PO BOX 10126
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0126
Mailing Address - Country:US
Mailing Address - Phone:219-736-0003
Mailing Address - Fax:219-756-2315
Practice Address - Street 1:9111 BROADWAY
Practice Address - Street 2:SUITE Q
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-0003
Practice Address - Fax:219-756-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100389940AMedicaid
IN100389940Medicaid
IN100389940AMedicaid