Individual
MARY K DE GROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 944-5000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042391A
IN
103TC0700X
Clinical Psychologist
5892
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000644074
ANTHEM PTAN
IN
05
—
200973950
—
IN
Enumeration date
08/04/2009
Last updated
03/06/2025
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