Provider Demographics
NPI:1154346047
Name:UNIVERSAL BEHAVIORAL SERVICE
Entity type:Organization
Organization Name:UNIVERSAL BEHAVIORAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:INDINAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-684-0442
Mailing Address - Street 1:3590 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4425
Mailing Address - Country:US
Mailing Address - Phone:317-684-0442
Mailing Address - Fax:317-684-0679
Practice Address - Street 1:3590 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4425
Practice Address - Country:US
Practice Address - Phone:317-684-0442
Practice Address - Fax:317-684-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000221075OtherANTHEM
IN149850Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER