Healthcare Provider Details

I. General information

NPI: 1366449043
Provider Name (Legal Business Name): MEDICAL PSYCHOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9780 LANTERN RD SUITE 210
FISHERS IN
46038-4092
US

IV. Provider business mailing address

9780 LANTERN RD SUITE 210
FISHERS IN
46037-4092
US

V. Phone/Fax

Practice location:
  • Phone: 317-578-4213
  • Fax: 317-578-9511
Mailing address:
  • Phone: 317-578-4213
  • Fax: 317-578-9511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number57000024A
License Number StateIN

VIII. Authorized Official

Name: DR. JAMES RICE
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: RHD
Phone: 317-578-4213