Provider Demographics
NPI:1487741633
Name:SOPER CONSULTING, PC
Entity type:Organization
Organization Name:SOPER CONSULTING, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-626-2462
Mailing Address - Street 1:7166 SUMMER OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062
Mailing Address - Country:US
Mailing Address - Phone:317-626-2462
Mailing Address - Fax:317-774-1531
Practice Address - Street 1:12999 PARKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:317-579-9356
Practice Address - Fax:317-774-1531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOPER CONSULTING, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN57000107A103TM1800X
IN20040752A103TB0200X, 103TM1800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty