Provider Demographics
NPI:1699238824
Name:PREMIER PSYCHOLOGY OF INDIANA, LLC
Entity type:Organization
Organization Name:PREMIER PSYCHOLOGY OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:317-414-0466
Mailing Address - Street 1:1347 CLAY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9753
Mailing Address - Country:US
Mailing Address - Phone:317-414-0466
Mailing Address - Fax:
Practice Address - Street 1:11350 N MERIDIAN ST STE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3531
Practice Address - Country:US
Practice Address - Phone:317-414-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty