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General NPI Number Information
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NPI Number | 1215201926
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Entity Type | Organization
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Legal Business Name | SHINING TIMES PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 3077 E 98TH ST SUITE 170
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-2940
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Country | US
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Telephone | 317-566-2814
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Fax | 317-566-2815
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Provider Business Mailing Address
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Address Line | 3077 E 98TH ST SUITE 170
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-2940
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Country | US
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Telephone | 317-566-2814
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Fax | 317-566-2815
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Authorized Official
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Title or Position | CLINICAL CHILD PSYCHOLOGIST
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Name | DR. ANNE KATHERINE CONLEY-GOLDSTEIN
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Credential | PH.D., HSPP
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Telephone | 317-566-2814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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