Healthcare Provider Details

I. General information

NPI: 1396900601
Provider Name (Legal Business Name): PARRISH-SPROWL & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 CARROLLTON AVE
INDIANAPOLIS IN
46220-1617
US

IV. Provider business mailing address

6524 CARROLLTON AVE
INDIANAPOLIS IN
46220-1617
US

V. Phone/Fax

Practice location:
  • Phone: 317-413-7642
  • Fax:
Mailing address:
  • Phone: 317-413-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number34003497A
License Number StateIN

VIII. Authorized Official

Name: DR. SUSAN PARRISH-SPROWL
Title or Position: VICE-PRESIDENT
Credential: PH.D., LCSW
Phone: 13174137642