Organization
HOPE HAVEN PSYCHOLOGICAL RESOURCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANIE D HEATH (BILLING AND INSURANCE MANAGER)
(317) 241-4673
Entity
Organization
Contact information
Practice address
125 N SHORTRIDGE RD, INDIANAPOLIS, IN 46219-4908
(317) 241-4673
(317) 241-0201
Mailing address
125 N SHORTRIDGE RD, INDIANAPOLIS, IN 46219-4908
(317) 241-4673
(317) 241-0201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042331A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200976490
—
IN
05
—
201059010B
—
IN
Enumeration date
10/19/2011
Last updated
04/17/2024
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