1649325408 NPI number — CENTER FOR CHILD AND FAMILY THERAPY

Table of content: (NPI 1649325408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649325408 NPI number — CENTER FOR CHILD AND FAMILY THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR CHILD AND FAMILY THERAPY
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:
1649325408
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:
9247 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-815-6030
Provider Business Mailing Address Fax Number:
317-815-6031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9247 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-815-6030
Provider Business Practice Location Address Fax Number:
317-815-6031
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEESNER
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PSYCHOLOGIST PRESIDENT
Authorized Official Telephone Number:
317-815-6030

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  20040841A , 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)

  • Identifier: 1095259 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: WEESN0001 . This is a "COMPCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004619395 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31600 . This is a "CERIDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000202009 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 157012253003 . This is a "CORPHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P11129664 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 025314 . This is a "MHN" identifier . This identifiers is of the category "OTHER".




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