Provider Demographics
NPI:1700885050
Name:AP & C CLINIC INC
Entity Type:Organization
Organization Name:AP & C CLINIC INC
Other - Org Name:ASSOCIATED PSYCHOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:812-232-2144
Mailing Address - Street 1:2901 OHIO BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2239
Mailing Address - Country:US
Mailing Address - Phone:812-232-2144
Mailing Address - Fax:812-234-4598
Practice Address - Street 1:2901 OHIO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2239
Practice Address - Country:US
Practice Address - Phone:812-232-2144
Practice Address - Fax:812-234-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN57000054A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251640AMedicaid
IN100251640AMedicaid