Healthcare Provider Details

I. General information

NPI: 1124674908
Provider Name (Legal Business Name): INDIANAPOLIS NEUROBEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E 91ST ST STE 101
INDIANAPOLIS IN
46240-1550
US

IV. Provider business mailing address

70 E 91ST ST STE 101
INDIANAPOLIS IN
46240-1550
US

V. Phone/Fax

Practice location:
  • Phone: 317-830-5859
  • Fax: 317-647-4491
Mailing address:
  • Phone: 317-830-5859
  • Fax: 317-647-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA SLONAKER
Title or Position: PRESIDENT/OWNER
Credential: PH.D.
Phone: 317-830-5859