Provider Demographics
NPI:1518577998
Name:PEACEFUL PRESENCE PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PEACEFUL PRESENCE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEUKAM-HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-630-9183
Mailing Address - Street 1:6441 CREEKSHORE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5079
Mailing Address - Country:US
Mailing Address - Phone:812-630-9183
Mailing Address - Fax:
Practice Address - Street 1:1311 W 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1191
Practice Address - Country:US
Practice Address - Phone:812-630-9183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty