Provider Demographics
NPI:1598123028
Name:SOUTHEAST INDIANA MENTAL HEALTH PROFESSIOALS, LLC
Entity Type:Organization
Organization Name:SOUTHEAST INDIANA MENTAL HEALTH PROFESSIOALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:HSSP
Authorized Official - Phone:812-346-2872
Mailing Address - Street 1:257 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1501
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:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99069246A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty