Provider Demographics
NPI:1740991223
Name:PSYCHOLOGY PRACTICE, PC
Entity type:Organization
Organization Name:PSYCHOLOGY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHEVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:777-388-8314
Mailing Address - Street 1:222 INDIANAPOLIS BLVD STE 207-5
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1276
Mailing Address - Country:US
Mailing Address - Phone:773-888-3148
Mailing Address - Fax:
Practice Address - Street 1:222 INDIANAPOLIS BLVD STE 207-5
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1276
Practice Address - Country:US
Practice Address - Phone:773-888-3148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty