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101 W Kirkwood Ave Suite 121 Bloomington IN 47404-6129 | |
| (812) 322-4109 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 101 W Kirkwood Ave, Bloomington, Indiana |
| Authorized Official Name and Position | Nicki Williamson (OWNER) |
| Authorized Official Contact | 8123224109 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
101 W Kirkwood Ave Suite 121 Bloomington IN 47404-6129 Ph: (812) 322-4109 | 101 W Kirkwood Ave Suite 121 Bloomington IN 47404-6129 Ph: (812) 322-4109 |
| NPI Number | 1760751069 |
|---|---|
| Provider Enumeration Date | 12/16/2011 |
| Last Update Date | 12/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760751069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 34005688A (Indiana) | Primary |
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