Provider Demographics
NPI:1447585823
Name:MEDPSYCH CONSULTANTS PC
Entity Type:Organization
Organization Name:MEDPSYCH CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-335-3871
Mailing Address - Street 1:17330 W CENTER RD
Mailing Address - Street 2:SUITE 110-282
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2392
Mailing Address - Country:US
Mailing Address - Phone:317-446-9288
Mailing Address - Fax:
Practice Address - Street 1:9904 RIDGEWAY CT
Practice Address - Street 2:
Practice Address - City:MC CORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9790
Practice Address - Country:US
Practice Address - Phone:317-335-3871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2004029A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty