Provider Demographics
NPI:1568790962
Name:DUNCAN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:DUNCAN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD HSPP
Authorized Official - Phone:812-234-4642
Mailing Address - Street 1:PO BOX 3166
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803
Mailing Address - Country:US
Mailing Address - Phone:812-234-4642
Mailing Address - Fax:812-234-7314
Practice Address - Street 1:127 N 1000 E
Practice Address - Street 2:
Practice Address - City:CELESTINE
Practice Address - State:IN
Practice Address - Zip Code:47521
Practice Address - Country:US
Practice Address - Phone:812-234-4642
Practice Address - Fax:812-234-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041336A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000185597OtherBLUE CROSS BLUE SHIELD
IN200198840BMedicaid
IN149460Medicare PIN