Provider Demographics
NPI:1972713295
Name:PELLAND PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:PELLAND PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:PELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-235-2600
Mailing Address - Street 1:1400 E PUGH DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3942
Mailing Address - Country:US
Mailing Address - Phone:812-235-2600
Mailing Address - Fax:812-235-0571
Practice Address - Street 1:1400 E PUGH DR
Practice Address - Street 2:SUITE 14
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3942
Practice Address - Country:US
Practice Address - Phone:812-235-2600
Practice Address - Fax:812-235-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040569A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000476204OtherANTHEM BC & BS PIN