Provider Demographics
NPI:1588868137
Name:WESTSIDE COUNSELING & PSYCHOLOGICA SERVICES, PC
Entity type:Organization
Organization Name:WESTSIDE COUNSELING & PSYCHOLOGICA SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSMUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:317-328-1200
Mailing Address - Street 1:3850 SHORE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5621
Mailing Address - Country:US
Mailing Address - Phone:317-328-1200
Mailing Address - Fax:317-328-1200
Practice Address - Street 1:3850 SHORE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5621
Practice Address - Country:US
Practice Address - Phone:317-328-1200
Practice Address - Fax:317-328-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040222A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184223OtherANTHEM BC BS
IN000000184223OtherANTHEM BC BS