MEDICARE: MONUMENTAL BEHAVIORAL HEALTH INC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1295205615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONUMENTAL BEHAVIORAL HEALTH INC

Provider Business Mailing Address
First Line	:	1201 N POST RD STE C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4246
Country	:	US
Telephone Number	:	317-405-8833
Fax Number	:	317-672-2398

Provider Business Practice Location Address
First Line	:	1201 N POST RD STE C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4246
Country	:	US
Telephone Number	:	317-405-8333
Fax Number	:	317-672-2398

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT MOCHEK
Credential	:
Telephone Number	:	317-370-1254

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	04/17/2019

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