Healthcare Provider Details

I. General information

NPI: 1740725738
Provider Name (Legal Business Name): LPS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 MEADOWS DR
MARTINSVILLE IN
46151-9450
US

IV. Provider business mailing address

3630 MEADOWS DR
MARTINSVILLE IN
46151-9450
US

V. Phone/Fax

Practice location:
  • Phone: 765-318-1225
  • Fax: 800-596-3681
Mailing address:
  • Phone: 765-318-1225
  • Fax: 800-596-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040289
License Number StateIN

VIII. Authorized Official

Name: MRS. ELIZABETH ANN ROBISON
Title or Position: CEO
Credential: LMHC
Phone: 765-318-1225