Healthcare Provider Details

I. General information

NPI: 1588294573
Provider Name (Legal Business Name): REBECCA MICHELLE KINSEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA MICHELLE ANGEL PHD

II. Dates (important events)

Enumeration Date: 01/19/2020
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 N MERIDIAN ST STE 300
CARMEL IN
46032-3531
US

IV. Provider business mailing address

11350 N MERIDIAN ST STE 300
CARMEL IN
46032-3531
US

V. Phone/Fax

Practice location:
  • Phone: 317-284-9335
  • Fax:
Mailing address:
  • Phone: 317-284-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20043292A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: