Provider Demographics
NPI:1780188045
Name:RICKE PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:RICKE PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-504-9252
Mailing Address - Street 1:16716 BROOKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7148
Mailing Address - Country:US
Mailing Address - Phone:317-504-9252
Mailing Address - Fax:
Practice Address - Street 1:9245 N MERIDIAN ST STE 225
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1812
Practice Address - Country:US
Practice Address - Phone:317-818-9000
Practice Address - Fax:317-818-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069546A261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health