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2020 Union St Suite 101 Lafayette IN 47904-3432 | |
| (765) 449-8286 | |
| (765) 449-0445 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 2020 Union St, Lafayette, Indiana |
| Authorized Official Name and Position | Martha K Miller (DIRECTOR OF BILLING) |
| Authorized Official Contact | 7654465286 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 4699 Lafayette IN 47903-4699 Ph: (765) 449-2732 | 2020 Union St Suite 101 Lafayette IN 47904-3432 Ph: (765) 449-8286 |
| NPI Number | 1366617896 |
|---|---|
| Provider Enumeration Date | 04/25/2008 |
| Last Update Date | 04/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366617896 | NPI | - | NPPES |
| 200107480P | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (Indiana) | Primary |
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