Provider Demographics
NPI:1467650754
Name:CADWELL PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:CADWELL PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:574-936-3031
Mailing Address - Street 1:310 N MICHIGAN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1770
Mailing Address - Country:US
Mailing Address - Phone:574-936-3031
Mailing Address - Fax:
Practice Address - Street 1:310 N MICHIGAN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1770
Practice Address - Country:US
Practice Address - Phone:574-936-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042025A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty