Healthcare Provider Details

I. General information

NPI: 1447277421
Provider Name (Legal Business Name): VALLE VISTA GUIDANCE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 E MAIN ST 4
GREENWOOD IN
46143-1440
US

IV. Provider business mailing address

896 E MAIN ST 4
GREENWOOD IN
46143-1440
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-2121
  • Fax: 317-887-5731
Mailing address:
  • Phone: 317-887-2121
  • Fax: 317-887-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAKU V PATEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 317-887-2121