Provider Demographics
NPI:1811506769
Name:MIDWEST SUPERVISION AND EVALUATION
Entity type:Organization
Organization Name:MIDWEST SUPERVISION AND EVALUATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-476-7272
Mailing Address - Street 1:8103 E US HIGHWAY 36 STE 123
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7964
Mailing Address - Country:US
Mailing Address - Phone:317-476-7272
Mailing Address - Fax:317-762-7916
Practice Address - Street 1:450 E 96TH ST STE 500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3760
Practice Address - Country:US
Practice Address - Phone:317-476-7272
Practice Address - Fax:317-762-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty