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General NPI Number Information
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NPI Number | 1265736615
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Entity Type | Organization
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Legal Business Name | THE HOPE SOURCE INC.
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 8350 CRAIG ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-3593
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Country | US
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Telephone | 317-578-0410
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Fax | 317-436-7409
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Provider Business Mailing Address
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Address Line | 8350 CRAIG ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-3593
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Country | US
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Telephone | 317-578-0410
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Fax | 317-578-0520
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Authorized Official
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Title or Position | EXECUTIVE CLINICAL DIRECTOR
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Name | DR. MOMI YAMANAKA
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Credential | PH.D. HSPP
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Telephone | 317-517-8817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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