Healthcare Provider Details

I. General information

NPI: 1245281963
Provider Name (Legal Business Name): DENNIS RAY KINDER PHD HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 N MERIDIAN ST STE 100
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

9106 N MERIDIAN ST STE 100
INDIANAPOLIS IN
46260
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-9111
  • Fax: 317-571-4470
Mailing address:
  • Phone: 317-575-9111
  • Fax: 317-571-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040044A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: