Healthcare Provider Details

I. General information

NPI: 1508304023
Provider Name (Legal Business Name): KRESS PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR STE 201
CARMEL IN
46032-5878
US

IV. Provider business mailing address

755 W CARMEL DR STE 201
CARMEL IN
46032-5878
US

V. Phone/Fax

Practice location:
  • Phone: 317-912-1500
  • Fax: 317-669-0541
Mailing address:
  • Phone: 317-912-1500
  • Fax: 317-669-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20042014A
License Number StateIN

VIII. Authorized Official

Name: DAVID KRESS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 317-912-1500