Provider Demographics
NPI:1407999543
Name:NORTHSIDE PSYCHOTHERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHSIDE PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:APRIL S. KATHERINE LYNCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL S. KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-202-0801
Mailing Address - Street 1:921 E 86TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1841
Mailing Address - Country:US
Mailing Address - Phone:317-202-0801
Mailing Address - Fax:317-253-8767
Practice Address - Street 1:921 E 86TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1859
Practice Address - Country:US
Practice Address - Phone:317-202-0801
Practice Address - Fax:317-253-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001711A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200532630AMedicaid
IN7550512Medicare UPIN
IN600011809Medicare UPIN
IN200532630AMedicaid