Provider Demographics
NPI:1972887479
Name:INTEGRITAS PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:INTEGRITAS PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:317-455-6782
Mailing Address - Street 1:910 N SHADELAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4810
Mailing Address - Country:US
Mailing Address - Phone:317-455-6780
Mailing Address - Fax:
Practice Address - Street 1:6239 S EAST ST
Practice Address - Street 2:SUITE E
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2090
Practice Address - Country:US
Practice Address - Phone:317-455-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042547A103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty