Healthcare Provider Details

I. General information

NPI: 1548808397
Provider Name (Legal Business Name): POSITIVEFMHS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W MAIN ST
MOORESVILLE IN
46158-1661
US

IV. Provider business mailing address

497 1/2 W JEFFERSON ST
FRANKLIN IN
46131-2111
US

V. Phone/Fax

Practice location:
  • Phone: 317-371-1681
  • Fax:
Mailing address:
  • Phone: 317-371-1681
  • Fax: 866-374-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RONALD J BEEBE
Title or Position: CHIEF PSYCHOLOGIST
Credential: LMFT, PSYD, HSPP
Phone: 317-371-1681