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General NPI Number Information
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NPI Number | 1265061998
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Entity Type | Organization
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Legal Business Name | GATEWAY PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 04/04/2020
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Provider Practice Location Address
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Address Line | 435 E MAIN ST STE 195
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City | GREENWOOD
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State | IN
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Zip | 46143-1456
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Country | US
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Telephone | 317-777-1852
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Fax |
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Provider Business Mailing Address
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Address Line | 8116 SINGLETON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2563
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Country | US
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Telephone | 317-777-1852
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN GALFORD
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Credential |
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Telephone | 317-777-1852
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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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