MEDICARE: DR. PATRICIA M COUVILLION PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20040357	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154338341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA M COUVILLION PH.D.

Provider Business Mailing Address
First Line	:	9240 N MERIDIAN ST
Second Line	:	STE 320
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1822
Country	:	US
Telephone Number	:	317-844-7489
Fax Number	:	317-581-1007

Provider Business Practice Location Address
First Line	:	10293 N MERIDIAN ST
Second Line	:	SUITE 375
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1123
Country	:	US
Telephone Number	:	317-581-2288
Fax Number	:	317-581-2295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/31/2019

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