Individual
BETH ANN BASTIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
6501 SUNNYSIDE RD, INDIANAPOLIS, IN 46236-9707
(317) 423-8226
Mailing address
6501 SUNNYSIDE RD, INDIANAPOLIS, IN 46236-9707
(317) 423-8226
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1107273
IL
103T00000X
Psychologist
Primary
966410
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1107273
CERTIFICATIONS
IL
01
—
966410
ILLINOIS AND INDIANA CERTIFICATIONS
IN
Enumeration date
07/25/2013
Last updated
03/18/2025
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