Provider Demographics
NPI:1649325408
Name:CENTER FOR CHILD AND FAMILY THERAPY
Entity type:Organization
Organization Name:CENTER FOR CHILD AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEESNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD HSPP
Authorized Official - Phone:317-815-6030
Mailing Address - Street 1:9247 N MERIDIAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1813
Mailing Address - Country:US
Mailing Address - Phone:317-815-6030
Mailing Address - Fax:317-815-6031
Practice Address - Street 1:9247 N MERIDIAN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1813
Practice Address - Country:US
Practice Address - Phone:317-815-6030
Practice Address - Fax:317-815-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040841A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1095259OtherCIGNA
WEESN0001OtherCOMPCARE
0004619395OtherAETNA
31600OtherCERIDIAN
000000202009OtherANTHEM
157012253003OtherCORPHEALTH
P11129664OtherMULTIPLAN
025314OtherMHN
000000202009OtherANTHEM