Dr Lullaby Llc | |
9445 Indianapolis Blvd Highland IN 46322-2648 | |
(844) 475-3379 | |
Not Available |
Full Name | Dr Lullaby Llc |
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Speciality | Clinic/Center |
Location | 9445 Indianapolis Blvd, Highland, Indiana |
Authorized Official Name and Position | Lisa Ann Medalie (CEO) |
Authorized Official Contact | 6199975759 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Dr Lullaby Llc 1440 W Taylor St Ste 556 Chicago IL 60607-4623 Ph: () - | Dr Lullaby Llc 9445 Indianapolis Blvd Highland IN 46322-2648 Ph: (844) 475-3379 |
NPI Number | 1679289615 |
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Provider Enumeration Date | 01/24/2023 |
Last Update Date | 01/27/2023 |
Certification Date | 01/27/2023 |
Medicare PECOS PAC ID | 9931507290 |
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Medicare Enrollment ID | O20230331002051 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679289615 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Secondary |
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Tyler Rickards |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1962807867 PECOS PAC ID: 3870881105 Enrollment ID: I20230331002244 |
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