| Hope Haven Psychological Resource, Llc | |
|
125 N Shortridge Rd Indianapolis IN 46219-4908 | |
| (317) 241-4673 | |
| (317) 241-0201 |
| Full Name | Hope Haven Psychological Resource, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 125 N Shortridge Rd, Indianapolis, Indiana |
| Authorized Official Name and Position | Tiffanie D Heath (BILLING AND INSURANCE MANAGER) |
| Authorized Official Contact | 3172414673 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope Haven Psychological Resource, Llc 125 N Shortridge Rd Indianapolis IN 46219-4908 Ph: (317) 241-4673 | Hope Haven Psychological Resource, Llc 125 N Shortridge Rd Indianapolis IN 46219-4908 Ph: (317) 241-4673 |
| NPI Number | 1679858831 |
|---|---|
| Provider Enumeration Date | 10/19/2011 |
| Last Update Date | 04/17/2024 |
| Certification Date | 04/17/2024 |
| Medicare PECOS PAC ID | 8527232214 |
|---|---|
| Medicare Enrollment ID | O20111115000161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679858831 | NPI | - | NPPES |
| 200976490 | Medicaid | IN | |
| 201059010B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 20042331A (Indiana) | Primary |
| Provider Name | Benetta E Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194977298 PECOS PAC ID: 1759434111 Enrollment ID: I20090803000079 |
| Provider Name | Arlinda D Lindsay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831467026 PECOS PAC ID: 6901065432 Enrollment ID: I20120302000003 |
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