Healthcare Provider Details

I. General information

NPI: 1477543684
Provider Name (Legal Business Name): FLAGSTONE PSYCHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7662 US HIGHWAY 31 S
INDIANAPOLIS IN
46227-8547
US

IV. Provider business mailing address

7662 US HIGHWAY 31 S
INDIANAPOLIS IN
46227-8547
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-5606
  • Fax: 317-888-5612
Mailing address:
  • Phone: 317-888-5606
  • Fax: 317-888-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number20040834
License Number StateIN

VIII. Authorized Official

Name: DR. APRIL J FAIDLEY
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 317-888-5606