| Great Lakes Institute For Neuropsychology & Behavioral Health | |
|
494 S Emerson Ave Suite C Greenwood IN 46143-1912 | |
| (317) 889-3901 | |
| (317) 889-3902 |
| Full Name | Great Lakes Institute For Neuropsychology & Behavioral Health |
|---|---|
| Speciality | Psychologist |
| Location | 494 S Emerson Ave, Greenwood, Indiana |
| Authorized Official Name and Position | Sanford Lloyd Pederson (PRESIDENT) |
| Authorized Official Contact | 3178893901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Institute For Neuropsychology & Behavioral Health Po Box 750233 Dayton OH 45475-0233 Ph: (317) 889-3901 | Great Lakes Institute For Neuropsychology & Behavioral Health 494 S Emerson Ave Suite C Greenwood IN 46143-1912 Ph: (317) 889-3901 |
| NPI Number | 1750599981 |
|---|---|
| Provider Enumeration Date | 05/20/2007 |
| Last Update Date | 06/07/2024 |
| Certification Date | 06/07/2024 |
| Medicare PECOS PAC ID | 5890733174 |
|---|---|
| Medicare Enrollment ID | O20050418001029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750599981 | NPI | - | NPPES |
| 200227370 | Medicaid | IN |
| Provider Name | Sanford L Pederson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659589885 PECOS PAC ID: 8426002585 Enrollment ID: I20050310001003 |
| Provider Name | Theresa Marie Greenlee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467731836 PECOS PAC ID: 2163696006 Enrollment ID: I20111110000864 |
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