Provider Demographics
NPI:1619218666
Name:BEECH TREE CONSULTING AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:BEECH TREE CONSULTING AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, HSPP
Authorized Official - Phone:317-780-5750
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107
Mailing Address - Country:US
Mailing Address - Phone:317-780-5750
Mailing Address - Fax:317-780-5755
Practice Address - Street 1:6249 S EAST ST
Practice Address - Street 2:SUITE I
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2091
Practice Address - Country:US
Practice Address - Phone:317-780-5750
Practice Address - Fax:317-780-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042288A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939250Medicaid
IN215040KOtherMEDICARE