Provider Demographics
NPI:1740057165
Name:SUNCREST PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:SUNCREST PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-701-7900
Mailing Address - Street 1:1241 CUMBERLAND AVE STE E
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1304
Mailing Address - Country:US
Mailing Address - Phone:657-017-9007
Mailing Address - Fax:
Practice Address - Street 1:1241 CUMBERLAND AVE STE E
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1304
Practice Address - Country:US
Practice Address - Phone:765-701-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty