| Thriveworks Telepsychiatry - Indiana PC | |
|
429 N Pennsylvania St Ste 111 Indianapolis IN 46204-1873 | |
| (855) 284-7483 | |
| Not Available |
| Full Name | Thriveworks Telepsychiatry - Indiana PC |
|---|---|
| Speciality | Counselor |
| Location | 429 N Pennsylvania St Ste 111, Indianapolis, Indiana |
| Authorized Official Name and Position | Anthony Centore (CEO) |
| Authorized Official Contact | 5402176461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thriveworks Telepsychiatry - Indiana PC Po Box 748465 Atlanta GA 30374-8465 Ph: (855) 284-7483 | Thriveworks Telepsychiatry - Indiana PC 429 N Pennsylvania St Ste 111 Indianapolis IN 46204-1873 Ph: (855) 284-7483 |
| NPI Number | 1881304418 |
|---|---|
| Provider Enumeration Date | 12/05/2022 |
| Last Update Date | 03/02/2023 |
| Certification Date | 03/02/2023 |
| Medicare PECOS PAC ID | 3779958467 |
|---|---|
| Medicare Enrollment ID | O20230411002451 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881304418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Secondary |
| Provider Name | Tina Chavis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053795435 PECOS PAC ID: 2062727027 Enrollment ID: I20150819009165 |
| Provider Name | Amy Greenfield Abuasabeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396260782 PECOS PAC ID: 4284907312 Enrollment ID: I20170912000136 |
| Provider Name | Aneel Ahmed Ursani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982085676 PECOS PAC ID: 3577863232 Enrollment ID: I20210330001330 |
| Provider Name | Christianah Agunanne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477212140 PECOS PAC ID: 8022493014 Enrollment ID: I20220912001491 |
| Provider Name | Jennifer Dawn Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033896188 PECOS PAC ID: 7618331745 Enrollment ID: I20230907004284 |
| Provider Name | Patricia Adeleye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316753502 PECOS PAC ID: 1456878859 Enrollment ID: I20250508003196 |
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