| Teague Psychological Services, Inc. | |
|
6470 N. Shadeland Suite C Indianapolis IN 46220 | |
| (317) 849-9509 | |
| (317) 841-1157 |
| Full Name | Teague Psychological Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6470 N. Shadeland, Indianapolis, Indiana |
| Authorized Official Name and Position | James Bradley Teague (PRESIDENT) |
| Authorized Official Contact | 3178499509 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teague Psychological Services, Inc. 6470 N. Shadeland Suite C Indianapolis IN 46220 Ph: (317) 849-9509 | Teague Psychological Services, Inc. 6470 N. Shadeland Suite C Indianapolis IN 46220 Ph: (317) 849-9509 |
| NPI Number | 1063782803 |
|---|---|
| Provider Enumeration Date | 01/11/2012 |
| Last Update Date | 01/11/2012 |
| Medicare PECOS PAC ID | 6204090905 |
|---|---|
| Medicare Enrollment ID | O20120608000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063782803 | NPI | - | NPPES |
| 100216740 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 20040735 (Indiana) | Primary |
| Provider Name | James B Teague |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821098922 PECOS PAC ID: 5193989895 Enrollment ID: I20120608000357 |
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