Individual
JAMES POLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1525 N RITTER AVE, INDIANAPOLIS, IN 46219-3026
(317) 359-5467
(317) 322-4095
Mailing address
6626 E 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
IN
1041C0700X
Clinical Social Worker
Primary
34007026A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000892238
ANTHEM
IN
05
—
100270530
—
IN
Enumeration date
10/07/2010
Last updated
10/07/2014
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