1457332710 NPI number — CLINICAL PSYCHOLOGICAL ASSESSMENT & CONSULTING, PC

Table of content: (NPI 1457332710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457332710 NPI number — CLINICAL PSYCHOLOGICAL ASSESSMENT & CONSULTING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PSYCHOLOGICAL ASSESSMENT & CONSULTING, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457332710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 S EAST ST
Provider Second Line Business Mailing Address:
PO BOX 7
Provider Business Mailing Address City Name:
CROTHERSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47229-9635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-793-2570
Provider Business Mailing Address Fax Number:
812-793-2570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 S EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROTHERSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47229-9635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-793-2570
Provider Business Practice Location Address Fax Number:
812-793-2570
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCIFRES
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRES, OWNER, CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
812-793-2570

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  57000116A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TH0100X , with the licence number: 57000116A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000381792 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 064755 . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 258751 . This is a "COMPSYCH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0393476 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 82272400 . This is a "MAGELLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000381784 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7627650 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C 231810 . This is a "UNITED AMERICAN INSURANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DE0072 . This is a "MEDICARE RAILROAD CARRIER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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