Healthcare Provider Details

I. General information

NPI: 1629349675
Provider Name (Legal Business Name): POSITIVE FOCUS MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 AUTUMN RUN
BARGERSVILLE IN
46106-8369
US

IV. Provider business mailing address

3170 AUTUMN RUN
BARGERSVILLE IN
46106-8369
US

V. Phone/Fax

Practice location:
  • Phone: 317-371-1681
  • Fax: 866-274-3065
Mailing address:
  • Phone: 317-371-1681
  • Fax: 866-274-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001531A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042164A
License Number StateIN

VIII. Authorized Official

Name: RONALD J BEEBE
Title or Position: PRESIDENT AND CEO
Credential: LMFT, PSYD, HSPP
Phone: 317-371-1681