Provider Demographics
NPI:1528371705
Name:SOUTHEAST INDIANA MENTAL HEALTH PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:SOUTHEAST INDIANA MENTAL HEALTH PROFESSIONALS, LLC
Other - Org Name:ROBERT E DAILEY AND ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELLSWORTH
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, HSPP
Authorized Official - Phone:812-346-2872
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-0475
Mailing Address - Country:US
Mailing Address - Phone:812-346-2872
Mailing Address - Fax:812-346-4172
Practice Address - Street 1:257 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1510
Practice Address - Country:US
Practice Address - Phone:812-346-2872
Practice Address - Fax:812-346-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty