Healthcare Provider Details

I. General information

NPI: 1548342306
Provider Name (Legal Business Name): CHILD & YOUTH DEVELOPMENT CENTER, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N MARR RD
COLUMBUS IN
47201
US

IV. Provider business mailing address

9900 SHELBYVILLE RD STE 11A
LOUISVILLE KY
40223-2965
US

V. Phone/Fax

Practice location:
  • Phone: 812-314-3500
  • Fax:
Mailing address:
  • Phone: 502-426-0152
  • Fax: 502-426-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ARCHANA BARRY
Title or Position: OWNER
Credential: M.D.
Phone: 502-426-0152