Organization
CHRISTIAN THEOLOGICAL SEMINARY
Active
Other names
Counseling Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARCEY SMITH (BILLING SUPERVISOR)
(317) 955-2499
Entity
Organization
Contact information
Practice address
1050 W 42ND ST, INDIANAPOLIS, IN 46208-3301
(317) 924-5205
(317) 931-2393
Mailing address
1000 W 42ND ST, INDIANAPOLIS, IN 46208-3301
(317) 924-5205
(317) 931-2393
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01019810A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000216006
ANTHEM GROUP NUMBER
IN
05
—
200196670A
—
IN
Enumeration date
06/14/2007
Last updated
10/04/2010
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