Healthcare Provider Details

I. General information

NPI: 1962681031
Provider Name (Legal Business Name): STACIA L. HILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 E 46TH ST
INDIANAPOLIS IN
46205-2460
US

IV. Provider business mailing address

11763 KITTERY DR
FISHERS IN
46037-7862
US

V. Phone/Fax

Practice location:
  • Phone: 317-273-8897
  • Fax: 317-273-8862
Mailing address:
  • Phone: 317-915-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20041861A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: