Healthcare Provider Details

I. General information

NPI: 1245191196
Provider Name (Legal Business Name): ELOURDES PIERRE PAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 FOX HARBOUR LN
INDIANAPOLIS IN
46227-3823
US

IV. Provider business mailing address

2628 FOX HARBOUR LN
INDIANAPOLIS IN
46227-3823
US

V. Phone/Fax

Practice location:
  • Phone: 754-779-2810
  • Fax:
Mailing address:
  • Phone: 754-779-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3747PI801X
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: