Provider Demographics
NPI:1619184678
Name:COMMUNITY PSYCHOLOGICAL CONSULTANTS
Entity Type:Organization
Organization Name:COMMUNITY PSYCHOLOGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,HSPP
Authorized Official - Phone:317-574-1785
Mailing Address - Street 1:201 W 103RD ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1087
Mailing Address - Country:US
Mailing Address - Phone:317-574-1785
Mailing Address - Fax:317-574-1786
Practice Address - Street 1:201 W 103RD ST
Practice Address - Street 2:SUITE 280
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1087
Practice Address - Country:US
Practice Address - Phone:317-574-1785
Practice Address - Fax:317-574-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200051950AMedicaid
IN1326068495Medicare NSC