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General NPI Number Information
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NPI Number | 1346655412
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Entity Type | Organization
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Legal Business Name | GYDO, LLC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 9502 ANGOLA CT SUITE 4
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3177
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Country | US
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Telephone | 317-471-8780
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Fax | 317-454-0775
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Provider Business Mailing Address
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Address Line | 9502 ANGOLA CT SUITE 4
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3177
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Country | US
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Telephone | 317-471-8780
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Fax | 317-454-0775
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. ALLEN M RADER
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Credential | LCSW
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Telephone | 317-471-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34003862A
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License Number State | IN
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