Provider Demographics
NPI:1356536981
Name:MCNALLY KEEHN, REBECCA H (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:H
Last Name:MCNALLY KEEHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:H
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 5837
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-8167
Practice Address - Fax:317-944-9760
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9572103TC0700X
IN20042804A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201254030Medicaid
IN145590082Medicare PIN