Healthcare Provider Details

I. General information

NPI: 1295877900
Provider Name (Legal Business Name): HENDRICKS COUNTY PSYCHOTHERAPY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6291 CAMBRIDGE WAY STE 200
PLAINFIELD IN
46168-7905
US

IV. Provider business mailing address

6291 CAMBRIDGE WAY STE 200
PLAINFIELD IN
46168-7905
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-8436
  • Fax: 317-718-8438
Mailing address:
  • Phone: 317-718-8436
  • Fax: 317-718-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01037689A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200895380A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
IdentifierDP3057
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. PHILIP J. BORDERS
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 317-718-8436