| Psychotherapy Associates Of Kokomo, Llc | |
|
217 E Southway Blvd Ste 101 Kokomo IN 46902-3577 | |
| (765) 480-0594 | |
| Not Available |
| Full Name | Psychotherapy Associates Of Kokomo, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 217 E Southway Blvd Ste 101, Kokomo, Indiana |
| Authorized Official Name and Position | Stanley Thomas Antonelli (CEO/PSYCHOTHERAPIST) |
| Authorized Official Contact | 7654800594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy Associates Of Kokomo, Llc 217 E Southway Blvd Ste 101 Kokomo IN 46902-3577 Ph: (765) 480-0594 | Psychotherapy Associates Of Kokomo, Llc 217 E Southway Blvd Ste 101 Kokomo IN 46902-3577 Ph: (765) 480-0594 |
| NPI Number | 1447868906 |
|---|---|
| Provider Enumeration Date | 07/21/2020 |
| Last Update Date | 07/21/2020 |
| Certification Date | 07/21/2020 |
| Medicare PECOS PAC ID | 0143646323 |
|---|---|
| Medicare Enrollment ID | O20200818004107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447868906 | NPI | - | NPPES |
| Provider Name | Stanley T Antonelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720328446 PECOS PAC ID: 4284921883 Enrollment ID: I20160926001571 |
| Provider Name | Emily Edwards |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043826175 PECOS PAC ID: 4789037094 Enrollment ID: I20240201003892 |
| Provider Name | Karisa Vandeventer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992235030 PECOS PAC ID: 2668825985 Enrollment ID: I20240201004398 |
| Provider Name | Heather Hart |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1710531751 PECOS PAC ID: 2567815897 Enrollment ID: I20240201004445 |
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