Provider Demographics
NPI:1417216953
Name:KMV PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:KMV PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:VOGLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-884-3132
Mailing Address - Street 1:3209 W SMITH VALLEY RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8495
Mailing Address - Country:US
Mailing Address - Phone:317-884-3132
Mailing Address - Fax:317-884-3131
Practice Address - Street 1:3209 W SMITH VALLEY RD
Practice Address - Street 2:SUITE 232
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8495
Practice Address - Country:US
Practice Address - Phone:317-884-3132
Practice Address - Fax:317-884-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200410410A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty