Healthcare Provider Details

I. General information

NPI: 1366815615
Provider Name (Legal Business Name): PSI SERVICES OF INDIANA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 GEORGIA ST STE D
MERRILLVILLE IN
46410-6391
US

IV. Provider business mailing address

8120 GEORGIA ST STE D
MERRILLVILLE IN
46410-6391
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-8201
  • Fax: 219-756-8203
Mailing address:
  • Phone: 219-756-8201
  • Fax: 219-756-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. MELVIN OTIS SWOPE
Title or Position: OWNER/ EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 219-756-8201