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General NPI Number Information
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NPI Number | 1811506769
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Entity Type | Organization
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Legal Business Name | MIDWEST SUPERVISION AND EVALUATION
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 450 E 96TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3760
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Country | US
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Telephone | 317-476-7272
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Fax | 317-762-7916
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Provider Business Mailing Address
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Address Line | 8103 E US HIGHWAY 36 STE 123
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City | AVON
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State | IN
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Zip | 46123-7964
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Country | US
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Telephone | 317-476-7272
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Fax | 317-762-7916
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | COURTNEY DELONEY
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Credential | PHD
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Telephone | 317-476-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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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 | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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