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General NPI Number Information
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NPI Number | 1972887479
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Entity Type | Organization
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Legal Business Name | INTEGRITAS PSYCHOLOGICAL SERVICES INC.
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 6239 S EAST ST SUITE E
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2090
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Country | US
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Telephone | 317-455-6780
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Fax |
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Provider Business Mailing Address
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Address Line | 910 N SHADELAND AVE STE 1
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4810
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Country | US
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Telephone | 317-455-6780
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | ERIC M GUDAN
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Credential | PSY.D.
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Telephone | 317-455-6782
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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 | 20042547A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 20042547A
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License Number State | IN
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