Healthcare Provider Details

I. General information

NPI: 1275613341
Provider Name (Legal Business Name): LINK PSYCHOLOGICAL & CONSULTING SERV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 I STREET
LA PORTE IN
46350-5533
US

IV. Provider business mailing address

213 FARMWOOD DRIVE
LA PORTE IN
46350-1905
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20041588A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20041588A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number20041588A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20041588A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number20041588A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041588A
License Number StateIN

VIII. Authorized Official

Name: DR. NANCY H. LINK
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 219-324-7063