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5505 S County Road 475 E Selma IN 47383-9678 | |
(219) 714-7147 | |
(219) 627-1887 |
Full Name | |
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Speciality | Psychologist - Clinical |
Location | 5505 S County Road 475 E, Selma, Indiana |
Authorized Official Name and Position | Stacy L Wright (PSYCHOLOGIST) |
Authorized Official Contact | 2197147147 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5505 S County Road 475 E Selma IN 47383-9678 Ph: (219) 714-7147 | 5505 S County Road 475 E Selma IN 47383-9678 Ph: (219) 714-7147 |
NPI Number | 1144732264 |
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Provider Enumeration Date | 10/30/2017 |
Last Update Date | 08/09/2022 |
Certification Date | 08/09/2022 |
Identifier | Type | State | Issuer |
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1144732264 | NPI | - | NPPES |
669102 | Other | IN | BEACON HEALTH OPTIONS |
000000834190 | Other | IN | ANTHEM BLUE CROSS BLUE SHIELD |
200813850A | Medicaid | IN |