1609996388 NPI number — CHOICES PSYCHOLOGY CONSULTATION CENTER, INC.

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 1609996388 NPI number — CHOICES PSYCHOLOGY CONSULTATION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICES PSYCHOLOGY CONSULTATION CENTER, INC.
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:
1609996388
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:
10585 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 340
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46290-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-580-4008
Provider Business Mailing Address Fax Number:
317-580-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10585 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-580-4008
Provider Business Practice Location Address Fax Number:
317-580-4010
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KROIN
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-580-4008

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  20040360 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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