Provider Demographics
NPI:1255039079
Name:MODERN STRENGTH PSYCHOLOGY CENTER
Entity type:Organization
Organization Name:MODERN STRENGTH PSYCHOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-559-3221
Mailing Address - Street 1:9102 N MERIDIAN ST STE 550
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1899
Mailing Address - Country:US
Mailing Address - Phone:317-559-3221
Mailing Address - Fax:
Practice Address - Street 1:9102 N MERIDIAN ST STE 550
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1899
Practice Address - Country:US
Practice Address - Phone:614-448-6693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1053820083Medicaid
IN1548256795Medicaid