Provider Demographics
NPI:1780862672
Name:DKR PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:DKR PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUPSKA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-870-5660
Mailing Address - Street 1:1400 E PUGH DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3942
Mailing Address - Country:US
Mailing Address - Phone:812-870-5660
Mailing Address - Fax:812-235-2929
Practice Address - Street 1:1400 E PUGH DR
Practice Address - Street 2:SUITE 10
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3942
Practice Address - Country:US
Practice Address - Phone:812-870-5660
Practice Address - Fax:812-235-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041729A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2501409OtherCIGNA BEHAVIORAL HEALTH
2501409OtherCIGNA BEHAVIORAL HEALTH
255260Medicare PIN