1841683752 NPI number — MENTAL HEALTH ASSOCIATION OF INDIANA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841683752 NPI number — MENTAL HEALTH ASSOCIATION OF INDIANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH ASSOCIATION OF INDIANA
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:
6
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:
1841683752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1431 N. DELAWARE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-631-2000
Provider Business Mailing Address Fax Number:
317-631-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 N DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-631-2000
Provider Business Practice Location Address Fax Number:
317-631-2002
Provider Enumeration Date:
03/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HOOD
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
317-631-2000

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1497030662 . This is a "GROUP NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201041940A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 221700000X . This is a "ART THERAPIST" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 101YP2500X . This is a "PROFESSIONAL COUNSELOR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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