Individual
MARY K MILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-2353
(317) 948-0509
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20043316A
IN
103TB0200X
Cognitive & Behavioral Psychologist
Primary
20043316A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300053583
—
IN
Enumeration date
08/04/2021
Last updated
03/31/2022
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