Provider Demographics
NPI:1710613831
Name:GEORGE VESPER
Entity Type:Organization
Organization Name:GEORGE VESPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VESPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-807-0456
Mailing Address - Street 1:420 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1364
Mailing Address - Country:US
Mailing Address - Phone:317-807-0456
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1364
Practice Address - Country:US
Practice Address - Phone:317-807-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1770748048Medicaid