Provider Demographics
NPI:1538103254
Name:CRIDER-NASH, IRIS M (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:M
Last Name:CRIDER-NASH
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 S EAST ST
Mailing Address - Street 2:SUITE E-4
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1900
Mailing Address - Country:US
Mailing Address - Phone:317-781-0447
Mailing Address - Fax:317-781-0465
Practice Address - Street 1:5218 S EAST ST
Practice Address - Street 2:SUITE E-4
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1900
Practice Address - Country:US
Practice Address - Phone:317-781-0447
Practice Address - Fax:317-781-0465
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040287A103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN58387816OtherUBH
IN067516OtherVALUE OPTIONS
IN067516OtherVALUE OPTIONS