Healthcare Provider Details

I. General information

NPI: 1740991223
Provider Name (Legal Business Name): PSYCHOLOGY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 INDIANAPOLIS BLVD STE 207-5
SCHERERVILLE IN
46375-1276
US

IV. Provider business mailing address

222 INDIANAPOLIS BLVD STE 207-5
SCHERERVILLE IN
46375-1276
US

V. Phone/Fax

Practice location:
  • Phone: 773-888-3148
  • Fax:
Mailing address:
  • Phone: 773-888-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE MISHEVSKI
Title or Position: CEO
Credential: PSY.D.
Phone: 777-388-8314