Provider Demographics
NPI:1801918065
Name:MERIDIAN YOUTH PSYCHIATRIC CENTER PC
Entity type:Organization
Organization Name:MERIDIAN YOUTH PSYCHIATRIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN APN LMHC
Authorized Official - Phone:317-844-0055
Mailing Address - Street 1:210 E 91ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1569
Mailing Address - Country:US
Mailing Address - Phone:317-844-0055
Mailing Address - Fax:317-571-5040
Practice Address - Street 1:210 E 91ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1569
Practice Address - Country:US
Practice Address - Phone:317-844-0055
Practice Address - Fax:317-571-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health