Healthcare Provider Details

I. General information

NPI: 1144436825
Provider Name (Legal Business Name): OUTPATIENT BEHAVIORAL HEALTH, ST FRANCIS HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E SOUTHPORT RD STE. C
INDIANAPOLIS IN
46227-8592
US

IV. Provider business mailing address

650 E SOUTHPORT RD STE. C
INDIANAPOLIS IN
46227-8592
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-8383
  • Fax: 317-782-6929
Mailing address:
  • Phone: 317-783-8383
  • Fax: 317-782-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number34001094A
License Number StateIN

VIII. Authorized Official

Name: MR. MICHAEL F. KENNY
Title or Position: OUTPATIENT THERAPIST
Credential: LCSW,LMFT,ACSW
Phone: 317-783-8383