Healthcare Provider Details

I. General information

NPI: 1538103254
Provider Name (Legal Business Name): IRIS M CRIDER-NASH PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 S EAST ST SUITE E-4
INDIANAPOLIS IN
46227-1900
US

IV. Provider business mailing address

5218 S EAST ST SUITE E-4
INDIANAPOLIS IN
46227-1900
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-0447
  • Fax: 317-781-0465
Mailing address:
  • Phone: 317-781-0447
  • Fax: 317-781-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20040287A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: