Provider Demographics
NPI:1780961730
Name:ROAD APPLE PSYCHOTHERAPY
Entity type:Organization
Organization Name:ROAD APPLE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAROLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-780-7990
Mailing Address - Street 1:7911 12B RD
Mailing Address - Street 2:
Mailing Address - City:ARGOS
Mailing Address - State:IN
Mailing Address - Zip Code:46501-9568
Mailing Address - Country:US
Mailing Address - Phone:574-780-7990
Mailing Address - Fax:
Practice Address - Street 1:7911 12B RD
Practice Address - Street 2:
Practice Address - City:ARGOS
Practice Address - State:IN
Practice Address - Zip Code:46501-9568
Practice Address - Country:US
Practice Address - Phone:574-780-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty