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1404 S State Ave Indianapolis IN 46203-2009 | |
| (371) 787-4024 | |
| (317) 787-4364 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1404 S State Ave, Indianapolis, Indiana |
| Authorized Official Name and Position | Brian P Farley (VP & SECRETARY) |
| Authorized Official Contact | 6158616000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6100 Tower Cir Ste 1000 Franklin TN 37067-1509 Ph: (615) 861-6000 | 1404 S State Ave Indianapolis IN 46203-2009 Ph: (371) 787-4024 |
| NPI Number | 1235543596 |
|---|---|
| Provider Enumeration Date | 06/16/2014 |
| Last Update Date | 08/22/2023 |
| Certification Date | 08/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235543596 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Indiana) | Primary |
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