Healthcare Provider Details

I. General information

NPI: 1043527328
Provider Name (Legal Business Name): LINK PSYCHOLOGICAL & CONSULTING SERVICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 I ST
LA PORTE IN
46350-5533
US

IV. Provider business mailing address

213 FARMWOOD DR
LA PORTE IN
46350-1905
US

V. Phone/Fax

Practice location:
  • Phone: 219-324-1700
  • Fax: 219-362-1962
Mailing address:
  • Phone: 219-324-7063
  • Fax: 219-362-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002188A
License Number StateIN

VIII. Authorized Official

Name: NANCY LINK
Title or Position: PSYCHOLOGIST
Credential: PSY. D HSPP
Phone: 219-324-7063