Healthcare Provider Details

I. General information

NPI: 1942677281
Provider Name (Legal Business Name): PSYCHIATRIC MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 ENTERPRISE DR
ANDERSON IN
46013-9670
US

IV. Provider business mailing address

8465 KEYSTONE XING SUITE 210
INDIANAPOLIS IN
46240-4355
US

V. Phone/Fax

Practice location:
  • Phone: 317-870-1553
  • Fax: 317-757-8491
Mailing address:
  • Phone: 317-870-1396
  • Fax: 317-757-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01038074A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28076787A
License Number StateIN

VIII. Authorized Official

Name: MORRIS D LONG
Title or Position: CEO
Credential:
Phone: 574-339-3021