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General NPI Number Information
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NPI Number | 1588859524
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Entity Type | Organization
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Legal Business Name | IRELAND & LUZIO BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 3101 N GREEN RIVER RD
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City | EVANSVILLE
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State | IN
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Zip | 47715-1369
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Country | US
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Telephone | 812-479-1856
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Fax | 812-479-1864
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Provider Business Mailing Address
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Address Line | 3101 N GREEN RIVER RD
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City | EVANSVILLE
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State | IN
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Zip | 47715-1369
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Country | US
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Telephone | 812-479-1856
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Fax | 812-479-1864
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ALISON MARY MCDONALD
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Credential |
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Telephone | 812-479-1856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20010339
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License Number State | IN
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