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General NPI Number Information
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NPI Number | 1346712411
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Entity Type | Organization
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Legal Business Name | INDIGO PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 12/29/2018
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Last Update Date | 12/29/2018
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Provider Practice Location Address
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Address Line | 625 111TH AVE N
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City | NAPLES
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State | FL
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Zip | 34108-1825
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Country | US
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Telephone | 305-244-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 625 111TH AVE N
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City | NAPLES
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State | FL
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Zip | 34108-1825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST / OWNER
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Name | DAVID FUENTES
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Credential |
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Telephone | 305-244-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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